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Is the Double-Incision Eyelid Surgery Effective?


A study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery examined the double-incision approach for age-related upper eyelid changes.

A study examining the double-incision surgery on the upper eyelid in Asian female patients was published in the Journal of Plastic, Reconstructive & Aesthetic Surgery.1 In these patients, according to the authors, upper eyelid skin laxity, lateral hooding, and upper eyelid and brow asymmetry are often seen, but can be difficult to resolve completely with a single-incision surgery method. 

There were 51 patients, from September 2017 to March 2019, that had a double-incision surgery. The surgery was performed by a sub-brow incision, the skin and the subcutaneous tissues were excised, and the orbicularis oculi muscle (OOM) flap and muscular-cutaneous flap were separated.

The OOM flap was lifted and fixed to the periosteum through the sub-brow fat pad and covered by the upper muscular-cutaneous flap, according to the authors. Another incision was then made in the eyelid crease, through which the supratarsal upper eyelid skin, muscle, and orbital fat were excised, with the excessive tension alleviated, and the double fold eyelids were adjusted if needed. 

After the surgery, the surgery was evaluated by both the surgeon and the patient to decide on whether the results were poor, fair, good, very good, or excellent and then comparisons between before and after surgery brow position was accessed. 

Patients had a follow up about 12 months after surgery and most patients did not have any issues. There were 2 patients who both experienced cases of vomiting and transient numbness over the forehead and 3 patients who had revisions. The average surgeon and patient satisfaction scores at 6 months after surgery were 4.2 ± 0.6 (range 3.0–5.0) and 4.0 ± 0.7 (range 2.0–5.0) respectively and the brow position remained stable during the follow up period. 

The authors concluded that the double-incision approach is safe, effective, and an aesthetically pleasing option for treating patients with upper eyelid aging. 


1. Guo P, Zhang J, Yu Z, et al. Double-Incision approach with suspension of the orbicularis oculi muscle and relieving of tension for upper eyelid rejuvenation in Asian women. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2021;74(8):1900-1907. doi:10.1016/j.bjps.2020.12.024

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