Abstract
Background
“European-style double eyelid” blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity.
Methods
During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. The authors classified this complex deformity as mild, moderate, or severe based on the extent of adhesion and tissue insufficiency, and we performed preaponeurotic fat flap transfer in 47 eyes (44.3%), free fat graft in 35 eyes (33%), and free dermis-fat graft in 24 eyes (22.6%), respectively.
Results
The outcomes in 87 eyelids were judged as excellent; and the grading was excellent in 41 eyes (87.2%) that underwent preaponeurotic fat flap transfer, 30 eyes (85.7%) that received a free fat graft, and 16 eyes (66.7%) that received a free dermis-fat graft. The outcomes in only 3 eyes (2.8%) were evaluated as unsatisfactory.
Conclusions
The fundamental reasons behind this deformity were adhesion and tissue insufficiency above the supratarsal crease. The purpose of correction was to reconstruct the gliding system and restore the volume. The authors performed preaponeurotic fat flap transfer, free fat graft, and free dermis-fat graft and achieved satisfactory results. Great improvement in ptosis was achieved by releasing the adhesion and lowering the fold in patients with normal levator muscle function.
Level of Evidence IV
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 www.springer.com/00266.
This is a preview of subscription content, log in via an institution to check access.
References
Fakhro A, Yim HW, Kim YK, Nguyen AH (2015) The evolution of looks and expectations of Asian eyelid and eye appearance. Semin Plast Surg 29:135–144
Nguyen MQ, Hsu PW, Dinh TA (2009) Asian blepharoplasty. Semin Plast Surg 25:185–197
Chen WPD (2007) The concept of a glide zone as it relates to upper lid crease, lid fold, and application in upper blepharoplasty. Plast Reconstr Surg 119:379–386
Cho IC (2015) Revision upper blepharoplasty. Semin Plast Surg 29:201–208
Kim YW, Park HJ, Kim S (2000) Secondary correction of unsatisfactory blepharoplasty: removing multilaminated septal structure and grafting of preaponeurotic fat. Plast Reconstr Surg 106:1399–1404
Kim BG, Youn DY (2006) Management of adhesion using a pretarsal fibromuscular flap or graft in secondary blepharoplasty. Plast Reconstr Surg 117:782–789
Lee Y, Kwon S, Hwang K (2001) Correction of sunken and/or multiply folded upper eyelid by fascia-fat graft. Plast Reconstr Surg 107:15–19
Mendelson BC, Luo D (2015) Secondary upper lid blepharoplasty: a clinical series using the tarsal fixation technique. Plast Reconstr Surg 135:508e
Kim KK, Kim W, Oh SK, Kim HS (2017) High double eyelid fold correction using wide dual-plane dissection. Ann Plast Surg 78:365–370
Park SK, Kim BG, Shin YH (2011) Correction of superior sulcus deformity with orbital fat anatomic repositioning and fat graft applied to retro-orbicularis oculi fat for Asian eyelid. Aesthet Plast Surg 35:162–170
Chen SH, Mardini S, Chen HC et al (2004) Strategies for a successful corrective Asian blepharoplasty after previously failed revisions. Plast Reconstr Surg 114:1270–1277
Ellenbogen R (1986) Free autogenous pearl fat graft in the face: a preliminary report of a rediscovered technique. Ann Plast Surg 16:179–194
Mordick TG, Larossa D, Whitaker L (1992) Soft-tissue reconstruction of the face: a comparison of dermal-fat grafting and vascularized tissue transfer. Ann Plast Surg 29(5):390–396
Czyz CN, Foster JA, Wulc AE (2015) Superior sulcus volumetric rejuvenation utilizing dermis fat grafting. Aesthet Surg J 35(7):892–898
Wattanakrai K, Chiemchaisri N, Wattanakrai P (2016) Secondary blepharoplasty: correction of the high fold. Aesthet Plast Surg 40:914–920
Wolfort FG, Poblete JVP (1995) Ptosis after blepharoplasty. Ann Plast Surg 34:264–267
Baum SH, Mohr C (2018) Autologous dermis-fat grafts in head and neck patients: indications and evaluation in reconstructive surgery. J Cranio Maxillofac Surg 1:2–3. https://doi.org/10.1016/j.jcms.2018.07.009
Kumar NG, Thapliyal GK (2012) Free dermal fat graft for restoration of soft tissue defects in maxillofacial surgery. J Maxillofac Oral Surg 11(3):319–322
Funding
The authors received the funding support of Graduate Education Reform Project of Peking Union Medical College (No. 10023-2016-004-04).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Rights and permissions
About this article
Cite this article
Guo, S., Yang, M., Zhou, C. et al. Corrective Strategies for a Complex Deformity Caused by “European-Style Double Eyelid” Blepharoplasty in Asians. Aesth Plast Surg 43, 395–403 (2019). https://doi.org/10.1007/s00266-018-1262-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-018-1262-3