Aesthetic Plastic Surgery

, Volume 43, Issue 2, pp 404–411 | Cite as

A Flexible Suspension Technique of Blepharoplasty: Clinical Application and Comparison with Traditional Technique

  • Lei Pan
  • Yi Sun
  • Sheng Yan
  • Hangyan Shi
  • Tingting Jin
  • Jingyu Li
  • Lei Zhang
  • Sufan WuEmail author
Original Article Oculoplastic



Double-eyelid blepharoplasty is one of the most popular aesthetic surgeries in China. But the traditional method produces a hidebound double eyelid due to its rigid suturing between the skin and the tarsus. The authors of this article concluded a novel technique of “flexible suspension technique” compared with traditional blepharoplasty which is considered as a “rigid fixation technique.”


This is a retrospective study of two groups of 100 Chinese Han females, on whom double-eyelid blepharoplasty was performed, 50 cases by “flexible suspension technique” and the other 50 by “rigid fixation technique.” The basic procedure of “flexible suspension technique” is suturing the orbicularis oculi muscle to the septal extension. Thus, the surgical connection between skin and tarsus is flexible. The surgical results were evaluated and compared using the Global Aesthetic Improvement Scale and Visual Analogue Scale/Score.


The “very much improved” rate in the “flexible suspension technique” group was higher than that in the “rigid fixation technique” group (p < 0.05). Postoperative appearances of the “flexible suspension technique” group were also better than the “rigid fixation technique” group with less edema (p < 0.05) and slighter incision scars (p < 0.05). However, the incidences of asymmetry and fold loss were higher in the “flexible suspension technique” group (p < 0.05).


The flexible suspension technique blepharoplasty can obtain a more natural appearance and has less adverse effects and shorter recovery time.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Blepharoplasty Orbital septum Orbicularis oculi muscle Levator aponeurosis Dynamic 



Funding was provided by the General Project Funds from the Health Department of Zhejiang Province (Grant No. 2016KYB022).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study informed consent is not required.


  1. 1.
    Kim HS, Hwang K, Kim CK et al (2013) Double-eyelid surgery using septoaponeurosis junctional thickening results in dynamic fold in Asians. Plast Reconstr Surg Glob Open 1(2):1–9CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Dong WL, Inho B, Eul JC et al (2013) Eyelid dynamics and supratarsal crease appearance after double eyelid surgery. J Craniofac Surg 24(3):818–821CrossRefGoogle Scholar
  3. 3.
    Reid RR, Said HK, Yu M et al (2006) Revisiting upper eyelid anatomy: introduction of the septal extension. Plast Reconstr Surg 117:65–70CrossRefPubMedGoogle Scholar
  4. 4.
    John AM (2005) Upper blepharoplasty in the Asian patient: the “double eyelid” operation. J Fac Plast Clin N Am 13:47–64CrossRefGoogle Scholar
  5. 5.
    Rhoda SN, Fredric B, James L et al (2003) A randomized, double-blind, multicenter comparison of the efficacy and tolerability of restylane versus zyplast for the correction of nasolabial folds. Dermatol Surg 29:588–595Google Scholar
  6. 6.
    Hirohiko K, Raman M, Dinesh S (2009) Upper eyelid anatomy: an update. Ann Plast Surg 63(3):336–343CrossRefGoogle Scholar
  7. 7.
    Sangki J, Bradley NL, Richard KD (1999) The Asian upper eyelid: an anatomical study with comparison to the Caucasian eyelid. Arch Ophthalmol 117(7):907–912CrossRefGoogle Scholar
  8. 8.
    Sufan Wu, Shi Hangyan, Yan Sheng et al (2010) Combined anchor suture with external upper eyelid blepharoplasty in Asian patients. Arch Fac Plast Surg 12(4):230–234Google Scholar
  9. 9.
    Yeop C, Hyun GK, Yong SN (2017) Three skin zones in the Asian upper eyelid pertaining to the Asian blepharoplasty. J Craniofac Surg 28:892–897CrossRefGoogle Scholar
  10. 10.
    Er P, Yun-Fei N, Zhen-Jun W et al (2016) Aponeurosis of the levator palpebrae superioris in Chinese subjects: a live gross anatomy and cadaveric histological study. Medicine (Baltimore) 95(31):e4469CrossRefGoogle Scholar
  11. 11.
    Hirohiko K, Igal L, Dinesh S et al (2009) Orbital septum attachment on the levator aponeurosis in Asians: in vivo and cadaver study. Ophthalmology 116(10):2031–2035CrossRefGoogle Scholar
  12. 12.
    Flowers RS (1975) Aesthetic surgery of the eyelids. In: Marchac D (ed) Transactions of the 6th international congress of plastic and reconstructive surgery. Masson, ParisGoogle Scholar
  13. 13.
    Woo CC, Yong OK, Young SK et al (2002) Refinement of double eyelid plasty in asian patients: attachment of the septoaponeurotic union to the pretarsal dermis. Aesth Surg J 22(2):154–161CrossRefGoogle Scholar
  14. 14.
    Kun H, Seong KY, Dae JK (2018) Location of the septoaponeurosis junction relative to the tarsal plate in upper eyelids. J Craniofac Surg 29(4):1051–1053CrossRefGoogle Scholar
  15. 15.
    Jae SL, Weon-Jin P, Myoung-Soo S et al (1997) Simplified anatomic method of double-eyelid operation: septodermal fixation technique. Plast Reconstr Surg 100(1):170–178CrossRefGoogle Scholar
  16. 16.
    Kakizaki H, Zako M, Nakano T et al (2005) The levator aponeurosis consists of two layers that include smooth muscle. Ophthal Plast Reconstr Surg 21:379–382CrossRefPubMedGoogle Scholar
  17. 17.
    Jung IP, Min SP (2007) Double-eyelid operation: orbicularis oculi-levator aponeurosis fixation technique. Fac Plast Surg Clin N Am 15:315–326CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhouPeople’s Republic of China

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