Algorithm for Correction of Unaesthetic High Eyelid Folds

Abstract

Background: Unaesthetic high eyelid fold is a challenging problem for plastic surgeons. Several methods have been introduced to overcome different deformities. Decision-making on how to select the most appropriate procedure for each patient with diverse underlying causes requires ample surgical experience. The authors present an algorithm as a guideline to manage this situation. Methods: A retrospective review of planned surgical correction among 368 patients with high eyelid folds in accordance with the advocated algorithm covering 6 years was conducted, graded, and analyzed using both objective and subjective measurements. The follow-up period ranged from 1 month to 5 years (average, 7 months). Results: Of 368 cases, 232 (63.05%) were classified as having an excellent result, 96 (26.08%) as good, and 40 (10.87%) as fair. No poor results, defined as failure to reduce the fold, were found using this algorithm. The crease size before surgery, ranging from 9 to 13 mm (average, 10.345 mm), was reduced to 6 to 9 mm (average, 7.324 mm). Conclusions: The authors propose an algorithm to correct high eyelid folds supported by a clinical study over 6 years. Surgical techniques and rationale behind the procedures are discussed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.