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454satisfied; and 3, very satisfied. Complications and any complaints were recorded to assist further modification of our techniques or undergo revisional surgery. Statistical analysisAdobe Photoshop 6.0 was used to analyze the Figure 2　Measurement of the incisions (a) A line for incision measuring 1–1.2 cm (shown in red) is drawn. Three points (shown in blue) measuring 7–10 mm above the ciliary margin on both the right and left sides are determined on the line. The distances between a, b, and c and a1, b1, and c1 must be the same to achieve symmetric lid folds. (b) Pre-operative measurement of a young patient with little or no sagging eyelid skin. (c) The small to moderate amount of skin over the eyelid to be removed (marked in red) is drawn on both sides equally (width: 1.5–3.0 cm x height: 0.4–0.8 cm). Three points (shown in blue) measuring 7–10 mm above the ciliary margin on both the right and left sides of the lower lines are determined. The distances between a, b, and c and a1, b1, and c1 must be equal to achieve symmetric lid folds. (d) Pre-operative measurement of a middle-aged patient with moderate extent of sagging eyelid skin. (e) Redundant skin over the eyelid is pinched by Grafe fixation forceps and roughly determined the amount of skin to be removed. A large or full amount of redundant skin over the eyelid to be removed (marked in red) is drawn precisely on both sides equally (width: 2.5–4.0 cm x height: 1.0–2.5 cm). Three points (shown in blue) measuring 7–10 mm above the ciliary margin on both the right and left sides of the lower lines are determined. The distances between a, b, and c and a1, b1, and c1 must be equal to achieve symmetric lid folds. The distances between x, y, and z and x1, y1, and z1 must be equal to achieve symmetric brow heights. (f) Pre-operative measurement of an old patient with large extent of sagging eyelid skin.preoperative and postoperative images. The statis-tical analyses were performed using Prism 8 soft-ware (GraphPadSoftware, La Jolla, CA, USA). MRD1 was analyzed by paired t-test and expressed as mean ± S.D. (standard deviation). The differ-ences in preference between small and large lid fold size among ethnic groups were analyzed by