Pretarsal Orbicularis Oculi Preservation with Palpebral Margin Incision and Internal Fixation for Double Eyelid Blepharoplasty in East Asian Patients: A Retrospective Multicenter Cohort Study.

BACKGROUND

Natural double eyelid blepharoplasty in East Asian patients requires stable crease formation, rapid recovery, inconspicuous scarring, and coordinated eyelid movement. This study evaluated the clinical outcomes of pretarsal orbicularis oculi preservation with palpebral margin incision and internal fixation.

METHODS

This multicenter retrospective cohort study included 238 East Asian patients who underwent bilateral double eyelid blepharoplasty between June 2019 and April 2023. Patients were divided into a pretarsal orbicularis preservation group with palpebral margin incision and internal fixation (n = 121) and a conventional incisional blepharoplasty group (n = 117). Postoperative morphology, swelling, dynamic eyelid function, scar outcomes, FACE-Q scores, and adverse events were compared. Multivariable linear or logistic regression was used to adjust postoperative comparisons for age, sex, participating center, mild ptosis correction, and epicanthoplasty.

RESULTS

Baseline characteristics and the frequencies of concurrent mild ptosis correction and epicanthoplasty did not differ significantly between groups. Adjusted analyses showed similar natural curvature and bilateral symmetry, whereas the preservation group had lower early swelling scores, better blinking coordination and eye-closure naturalness, lower Vancouver Scar Scale scores, and higher scar satisfaction scores. FACE-Q Satisfaction with Eyes was higher at 6, 12, and 24 months; Psychological Well-being was higher at 6 and 12 months; and Satisfaction with Facial Appearance was higher at all postoperative time points. Total adverse events were less frequent in the preservation group (9.9% vs. 19.7%; adjusted OR, 0.42; 95% CI, 0.19-0.92; P = 0.030).

CONCLUSIONS

Pretarsal orbicularis oculi preservation with palpebral margin incision and internal fixation was associated with reduced early swelling, better dynamic eyelid function, improved scar quality, favorable patient-reported outcomes, and fewer overall adverse events compared with conventional incisional blepharoplasty.

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