To evaluate height and symmetry of double folds following simultaneous levator palpebral muscle resection and double eyelid blepharoplasty for correction of blepharoptosis.

We retrospectively studied 400 eyes of 286 patients who underwent simultaneous surgeries for double eyelid construction and correction of blepharoptosis from January 2006 to December 2011. All the patients were divided into three groups based on levator palpebrae muscle function: group A consisted of 82 eyes whose Levator Function Test (LFT) was 5 cm or less, group B consisted of 115 eyes whose LFT was between 5 and 10 cm, group C consisted of 203 eyes whose LFT was over 10 cm. For each group, we evaluated the preoperative marginal reflex distance 1 (MRD1), surgical methods, the postoperative height and symmetry of the double folds, and additional operations for correcting blepharoptosis.

Blepharoptosis surgery was performed in all groups by simultaneous levator resection and double eyelid blepharoplasty in all groups. Postoperative asymmetric double fold was the most common outcome observed in the poor levator function group A. Blepharoptosis under-correction was the most common cause of asymmetric double fold and its occurrence was statistically different between the three groups. The other causes were skin redundancy, brow elevation, double fold loosening, and blepharoptosis over-correction.

The height of a double eyelid can be changed postoperatively by changing levator palpebrae muscle function. In cases of poor levator function, the levator palpebrae muscle is positioned slightly lower than the normal double fold. This condition may result in further relapse or recurrence in the poor levator function group. Also, levator function should be considered among the diverse factors that determine the height of the double fold.