Free Orbital Fat Grafting During Upper Blepharoplasty in Asians to Prevent Multiple Upper Eyelid Folds and Sunken Upper Eyelids

Abstract

Background: Nowadays, a sharp, well-defined supratarsal fold and appropriate fullness of the upper eyelid tissue are considered important features of beautiful and youthful eyes. Individuals with thin upper eyelid tissue are at high risk of developing multiple upper eyelid folds and/or sunken appearance after upper blepharoplasty. Innovatively, the authors propose the application of free orbital fat grafting to the postorbicularis oculi space during upper blepharoplasty in order to achieve better aesthetic results. Methods: Fifty Chinese patients with congenital single eyelids combined with mildly sunken upper eyelid tissue were operated on between June 2017 and October 2018. During blepharoplasty, the lateral portion of the orbital septum was dissected, and appropriate lateral orbital fat was harvested. When the double-eyelid fold was formed and skin was interruptedly sutured, the harvested fat was divided into several pieces each side according to the sunken depth, and they were used to replace a layer on two-thirds of the central region of the supraseptal skin-muscle flap through the zipping gaps. Results: Forty-five patients underwent the follow-up interview for 6 to 18 months with a mean period of 10 months. The satisfaction rate was 82%. No significant asymmetry, irregularities, and sunken upper eyelid and multiple upper eyelid folds occurred. Conclusion: The lateral orbital fat grafting to the central region of the supraseptal skin-muscle flap during upper blepharoplasty is an effective and simple method to correct or prevent multiple upper eyelid folds and/or sunken upper eyelid in Asians.

Revisional Asian Blepharoplasty of the High Eyelid Fold: Tarsus-Orbicularis Fixation Combined With Orbital Fat Repositioning Technique

“…The results proved to be satisfactory during 6 months follow-up, and no complication was observed in these cases. In our opinion, free orbital fat grafting from the lower eyelid is a great option for those with insufficient residual orbital fat in the upper eyelid 16…”

Sunken Upper Eyelid Deformity Correction by Orbital Fat Pad Repositioning and Orbicularis Oculi Muscle Folding in Blepharoplasty

“…In addition, possible injury to the orbital septum during routine blepharoplasty can cause scar-related adhesion and multiple eyelid folds. 6 Multiple eyelid folds can intensify the senile and gaunt appearance of the upper eyelid. They are difficult to correct and tend to recur with the failure of volume restoration.…”

“…In addition to the orbital fat depletion, injury to the orbital septum during conventional blepharoplasty can cause multiple eyelid folds due to adhesion between the levator aponeurosis and orbicularis oculi muscle or skin. 6 Multiple eyelid fold lines are difficult to correct and harmful to patients physically and mentally. 2 Therefore, the restoration of an adequate amount of soft tissue in the upper eyelid to prevent multiple eyelid folds is as important as the creation of a supratarsal fold for patients with sunken eyelids.…”

“…In individuals with sunken upper eyelids, the orbital fat between the levator aponeurosis and orbicularis oculi muscle is insufficient to act as a gliding cushion when lifting the upper eyelids. In addition to the orbital fat depletion, injury to the orbital septum during conventional blepharoplasty can cause multiple eyelid folds due to adhesion between the levator aponeurosis and orbicularis oculi muscle or skin 6. Multiple eyelid fold lines are difficult to correct and harmful to patients physically and mentally 2.…”

Correction of Mild-to-Moderate Sunken Upper Eyelids of Asians with Stromal Vascular Fraction Gel

“…A single eye was evaluated as a single sample. The sunken depths were graded as follows: less than 5 mm, mild; between 5 and 10 mm, moderate; and more than 10 mm, severe [ 23 ]. The study only included patients with a mild or moderate upper eyelid sulcus deepening.…”