Objective　To explore the feasibility and effectiveness of the split retro-orbicularis oculi fat (ROOF) resection

technique for the correction of bulky upper eyelid in double-eyelid surgery. Methods　From 2018 to 2022, a total of 456 cases

of double eyelid surgery with bulky upper eyelid were treated with the split ROOF resection technique. After fully dissection of

ROOF pad, the fat was split from the anterior orbital septum, so as to completely preserve the anterior orbital septum while removing ROOF to the maximum extent. Meanwhile, appropriate amount of orbital septum fat and part of orbicularis oculi muscle

were removed. The eyelid was sutured in layers so that the tension of the orbicularis oculi muscle does not directly act on the

eyelid skin. There were 158 patients in 456 cases with different degrees of ptosis. They were corrected by levator palpebrae superioris shortening during the double eyelid blepharoplasty. Results　The 456 patients were followed up for 3-48 months, with

an average of 26.3 months. Among the 456 patients, 454 cases formed stable double eyelid fold, and two cases became shallow

and disappeared 15 months and 18 months after surgery, respectively. The appearance of bulky eyelid was significantly improved

in all patients, 20 patients had depigmentation at the surgical incision site, and no sunken scar, triple eyelid and other complications occurred. Conclusion　Split ROOF removal combined with eyelid layering suture technique can effectively improve bulky

upper eyelid, form a stable appearance of double eyelid, and prevent postoperative complications such as sunken scar and triple

eyelid.

Retro-orbicularis oculi fat, 　Double-eyelid blepharoplasty, 　Bulky upper eyelid