Double-eyelid operation: orbicularis oculi-levator aponeurosis fixation technique.

Incision techniques in the past focused on fixing the pretarsal skin to either the tarsal plate or to the levator aponeurosis. High relapse rate remains one of the main concerns in double-eyelid surgery. To address these issues, the author developed a pretarsal orbicularis oculi muscle-levator aponeurosis fixation technique. This technique results in better fixation between the skin and the levator aponeurosis by recruiting a bulky, pretarsal orbicularis oculi muscle in the fixation mechanism. This technique provides for a solidly fixed, tightly stretched pretarsal skin when the eyes are open with significantly reduced chances of relapse.