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(n=259)Large (n=140)P-valuen (%)5 (16)58 (87)9 (17)68 (64)<0.001458of the environmental and cultural ideal of beauty, a double eyelid is a desired facial characteristic among Asians17, 28). As Myanmar is a country where many ethnic groups with different environmental and cultural backgrounds19), individuals’ satisfaction upon size and shape of desired eyelid are different. Although the outcome of blepharoplasty itself was reported to be favorable and satisfied in previous study29), our incisional technique in most patients could result in a more satisfying and pleasing outcome by attaining not only a bilateral symmetric lid fold but also a favorable eyelash line direction. It is important to evaluate not only the esthetic outcomes but also the functional improvement after double eyelid surgery. Previous studies have shown that measurement of the MRD1 is an objective functional evaluation method after this surgery23, 25). Our study confirmed that the incisional techniques achieved functional improvement by increasing the Table 2　Differences in preference between small and large lid fold size among ethnic groupsFigure 7　Differences in preference between small and large lid fold size among ethnic groups. The graph shows different preference of desired eyelid fold size by the end of 6 months with very satisfied result. People in Kachin and Shan prefer small lid fold size. On the other hand, Bamar and other ethnic groups prefer large lid fold size.EthnicsKachin BamarShanOthers (Kayah, Karen, Chin, Mon, Rakhine)P-value by Chi-square testTotal Sample326753107Size of the lid foldSmall (n=119)n (%)27 (84)9 (13)44 (83)39 (36)MRD1 measurement after surgery to the patients of all ages (17-82 years old). It can also be thought that as the younger has stronger function of levator aponeurosis than the older, shortening the stronger levator aponeurosis can more effectively pull up the dermal-levator attachment and increase MRD1. On the other hand, weaker levator aponeurosis in the elder may additionally be needed to be removed the excessive sagging skin to be able to increase MRD1 in addition to dermal-levator fixation to achieve both effective aesthetical and functional outcomes.In this study, we performed double eyelid surgery and evaluated patient satisfaction at months 1, 2, 3, and 6 after surgery. Questionnaire survey for satis-factory were taken by telephone interview as there were some patients who were uncooperative to fill the survey form and send it back by air mail, unfa-miliar or unavailable to fill the survey form by internet in some rural areas and inconvenient to