Background <p>High-eyelid crease (HC) is one of the most common complications following blepharoplasty and is often accompanied by sunken upper eyelid, scar adhesion, or blepharoptosis, posing significant clinical challenges. Based on the anatomical and histological study of the glide zone and orbital fat fascia flap, this article provides an effective and comprehensive strategy for HC correction.</p> Methods <p>Gross anatomical dissections and histological studies were performed on 9 formalin-fixed cadaveric specimens to investigate the anatomical characteristics of the glide zone and the blood supply source of the orbital fat. Based on these findings, a technique preserving the vascular pedicle of the orbital fat fascia flap was utilized to reconstruct glide zone in 68 patients with HC.</p> Results <p>The orbital fat is encased by a relatively complete fascia. Its blood supply predominantly originates from the fascia, especially the inferior one, where longitudinally oriented vessels trunk enter the distal fat from the posterior region. Clinically, 68 cases with HC were treated. Of these, 62 cases were satisfied with good long-term outcomes (satisfaction rate: 91.18%), 1 case presented with shallow crease, 2 had asymmetric crease, and 3 required secondary revision for unilateral sunken upper eyelid.</p> Conclusion <p>Reconstruction of the glide zone using an orbital fat fascia flap that preserves its vascular pedicle provides a reliable anatomical basis for repairing high-eyelid creases. The technique has yielded satisfactory outcomes and is suitable for clinical application.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>