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452appearance with conservative excision of excess skin, muscle, and periorbital fat to restore the full-ness of the eyelid16). However, the perception of esthetically attractive eyes is variable. Moreover, the characteristics of an attractive eyelid differ not only according to age, gender, and individual pref-erence but also according to racial background17, 18). Nevertheless, depending on the individual’s desired appearance and functional improvement, an appro-priate technique should be chosen and applied for upper blepharoplasty. In Myanmar, there are several ethnic groups with different cultures and appearance as well as different facial contours19). Some people have the characteristic Asian single eyelid while others have an obvious double eyelid with a large suprapalpe-bral fold. However, most people in Myanmar have a preference for double eyelids with large, symmetric, and obvious folds, which are considered youthful and attractive. Although Myanmar is a developing country that is mainly based on agriculture, the country’s economic growth has progressed despite the 2008 financial crisis20). Since 2011, there has been a rapid growth of the concept of socioeconomic status in Myanmar21) whereby economic changes and the influence of films, advertising, and social media have encouraged people to seek esthetic proce-dures22). Before 2011, there were few private aesthetic dermatology clinics in Myanmar. Nowa-Figure 1　Anatomical differences between a single eyelid and a double eyelid (a) Diagram showing the anatomical structures of a double eyelid. The crease (dotted line) is formed by the superior aponeurotic attachments to the orbicularis muscle and eyelid skin. (b) Diagram showing the anatomical structures of a single eyelid. The crease is absent or indistinct. The lower attachment of the septum to the aponeurosis/tarsus allows fat to descend into the eyelid and blunt the aponeurotic attachments to the skin.days, there are many such cosmetic dermatology clinics throughout the country but still very few aesthetic plastic surgery clinics exist in Yangon.The aim of this study was to identify the tech-niques used and the outcomes of double eyelid surgery at a specialist clinic in Yangon, Myanmar. This study also described clinical challenges, diffi-culties in follow-up and patient care after double eyelid surgery in a limited environment in a devel-oping country. Patient demographics From December 2016 to November 2019, a total of 606 outpatients underwent double eyelid surgery at our clinic in Yangon. Data for 302 patients who did not attend the clinic for follow-up, those who did not wish to make their photographs available, those were not contactable, and those for whom clinical information was incomplete after removal of stitches were excluded. Finally, data for 304 patients (37 men, 267 women) aged 17-82 years were included in the study. Incisional double eyelid procedure was performed to all patients. Extent of redundant eyelid skin was removed to some patients with moderate or large extent of redun-dant eyelid skin that covered one third to half of the iris area above the pupil. Information on esthetic outcome, functional improvement and patient satisfaction was retro-Materials and Methods