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Kyi Chan KO1, 2), Hiroshi MIZUNO1)2)Quality Care Specialist Clinic, Yangon, MyanmarFunctional and Aesthetic Double Eyelid Surgery: Corresponding author: Kyi Chan KoDepartment of Plastic and Reconstructive Surgery, Juntendo University School of Medicine2-2-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, JapanTEL: +81-3-5802-1107　FAX: +81-3-5689-7813　E-mail: kyichanko@gmail.com〔Received　May. 21, 2021〕〔Accepted　Jun. 22, 2021〕J-STAGE Advance published date: Aug. 31, 2021Copyright © 2021 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ21-0006-OAObjective: Upper blepharoplasty surgery includes both esthetic and functional considerations. Double eyelid surgery is one of the most commonly performed facial plastic and esthetic surgical procedures in Asia. Although correctly performed procedures are esthetically pleasing for patients, there are many potential complications and complaints that need to be avoided. Myanmar is a country where there are many ethnic groups and people of different cultures, appearance, and preferences. The purpose of this study is to evaluate the surgical techniques and the outcome in a limited medical environment in Myanmar.Methods: Three hundred and four patients (37 men, 267 women) who underwent double eyelid surgery were enrolled in the study. The double eyelid fold was created by placing and attaching three points between the dermis and levator aponeurosis. The directions of eyelash lines were then adjusted to be inverted approximately 100° upwards on both sides. Satisfactory outcomes were assessed by contacting and surveying the patients’ feedback via telephone whereas functional outcomes were assessed by measuring marginal reflex distance (MRD1) who could visit back to the clinic.Results: The incisional technique healed very rapidly and looked natural within 1 month in young patients but only looked natural after 2 to 6 months in the elders. The MRD1 was increased on postoperative measurement of all patients (p<0.05). Nearly all the patients were aesthetically satisfied with the result by 6 months postoperatively.Conclusions: The outcomes were esthetically satisfying with functional improvement. This is the first retrospective clinical outcome study of double eyelid surgery in Myanmar.Key words: upper blepharoplasty, marginal reflex distance, clinical outcome study, developing countryJuntendo Medical Journal2021. 67(5), 451-462Original ArticlesChallenges and the First Clinical Outcome Study in MyanmarIntroductionThe anatomy of the Asian or single eyelid is characterized by the absence of a supratarsal fold because of the presence of an extensive preaponeu-rotic fat pad that is enclosed by the orbital septum and ends inferior to the tarsus, covering the attach-ment of the levator aponeurosis to the dermis. In contrast, a double eyelid has a supratarsal fold that is formed such that the orbital septum ends supe-rior to the tarsus, allowing attachment of the levator aponeurosis to the dermis1) (Figure 1).1)Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, JapanDouble eyelid surgery is one of the most commonly performed esthetic surgical procedures in Asian populations2-4). Various classifications, measurements, and concepts of double eyelid surgery have been described5-7). Different methods and several forms of double eyelid surgery have been proposed in reports from many countries8-14). Young people prefer a naturally prominent lid fold with less puffiness of the upper eyelids, widened vertical palpebral fissures, and everted eyelashes15) whereas middle-aged and older patients seek upper blepharoplasty to achieve a youthful eyelid 451