Mechanisms of supratarsal crease formation in incisional blepharoplasty among Asian patients: A review

The formation of a lasting and natural supratarsal crease remains the primary goal of incisional double-eyelid blepharoplasty in Asian patients. Surgical techniques have progressed from direct dermis-tarsus fixation to various methods designed to create a more dynamic supratarsal crease. Although these variations exist, differences in crease-formation methods are often described without clear explanations of their underlying mechanisms. The aim of this review is to provide a detailed comparison of the different structural mechanisms underlying supratarsal crease formation, with emphasis on full-incisional techniques commonly performed in Asian patients. A PubMed literature search of English-language articles published between January 2010 to December 2025 was conducted. Nineteen studies met the inclusion criteria and their techniques were evaluated based on key characteristics of supratarsal crease formation. These include: creation of primary tissue connections, fixation strategy, handling of tissue structures, postoperative crease behavior, and reported limitations. Four biomechanical groups based on the dominant fixation plane were identified. A clearer understanding of the different techniques in supratarsal crease formation can help guide surgical decision-making and improve functional and aesthetic outcomes in Asian supratarsal crease-forming blepharoplasty.