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DESPITE THE popularity of the double-eyelid operation, controversy exists among surgeons regarding the precise anatomical basis of the supratarsal fold and, thus, the most effective method for creation of natural and durable crease. The most commonly accepted anatomical explanation of the variation between the "single" and "double" eyelid attributes formation of the double lid to filaments of the levator expansion that penetrate the orbital septum and orbicularis muscle and attach to the overlying dermis.1 Such attachments (which, incidentally, have never been conclusively demonstrated either in gross or histological studies) are said to be absent in the single eyelid.
McCurdy JA. Orbicularis-Levator Fixation in Double-Eyelid Operation. Arch Facial Plast Surg. 1999;1(2):96. doi: