Correction of Severe Sunken Upper Eyelids By Preseptal Dissection and Autologous Fat Graft during Subbrow Blepharoplasty

Purpose

Various methods have been reported to correct sunken upper eyelids during eyelid surgery for dermatochalasis. However, previous surgical methods can be limited in severe sunken upper eyelids. We introduce more effective method to correct sunken upper eyelids by subbrow blepharoplasty approach.

 

Methods

From January 2015 to December 2017, 78 patients underwent subbrow blepharoplasty with sunken upper eyelids correction. Autologous fat was harvested from inner thigh or submentum. After removal of the excess skin and strip excision of the orbicularis oculi muscle, the procedure involved exposing retro-orbicularis oculi fat, dissecting along the plane between orbicularis oculi muscle and orbital septum up to the designed double fold line. Slit incision was done on orbital septum at the level of supra-orbital sulcus, and then micro fat graft was placed at the posterior of orbital septum and spreading at the dissected layer between orbital septum and orbicularis oculi muscle. After skin closure, non-incision double fold procedure were done with or without ptosis correction.

 

Results

After 6 months of follow up, a total of 74(0.95%) were satisfied with the result. The average amount of the fat graft was 1.1cc for each upper eyelid. Only 3 patients with the asymmetric double fold eyelids underwent reoperation. The absorption rate of fat graft was relatively lower than closed fat injection procedure. None of the patients showed complications such as irregular eyelid surface, eyelids opening limitation and multiple folds.

 

Conclusion

Our method using autologous fat graft after preseptal dissection during subbrow blepharoplasty is simple and could be effective for the correction of severe sunken upper eyelids and blepharoptosis.

 

 

References

1. Jung JM, Choi WS, Jo MS. Correction of the Sunken Upper Eyelid Depending on the Dermatochalasis or Blepharoptosis Using the Autologous Fat Grafting. Arch Aesthetic Plast Surg. 2014;20(3):148-154.
2. Park SK, Kim BG, Shin YH. Correction of Superior Sulcus Deformity With Orbital Fat Anatomic Repositioning and Fat Graft Applied to Retro-Orbicularis Oculi Fat for Asian Eyelids. Aesth Plast Surg. 2011;35:162–170.
3. Chen CC, Sheng NC, Chien LH. Correction of Sunken Upper-Eyelid Deformity in Young Asians by Minimally-Invasive Double-Eyelid Procedure and Simultaneous Orbital Fat Pad Repositioning: A One-Year Follow-up Study of 250Cases. Aesthetic Surgery Journal. 2015;35(4)359–366.