Secondary Upper Blepharoplasty: Converting Static Folds Into Dynamic Folds

Abstract

Background For the patients seeking secondary upper blepharoplasty, a static double-eyelid fold featuring an immobile lower flap and depression of the fold is common. Objectives In this study, the authors propose a novel technique of reconstructing pretarsal tissue defects (PTDs) to converting static folds to dynamic folds. Methods Two hundred three patients with static folds underwent revision surgery. After complete adhesion release of the lower flap, a PTD was identified, which was defined as an area deficient of orbicularis oculi muscle in front of the tarsal plate. If the width of the PTD was over 2 mm tissue transfer was performed to reconstruct the PTD, usually with a free retro-orbicularis oculus fat (ROOF) graft or a pretarsal orbicularis oculi flap. Results Among the 105 patients with severe static folds, 67 received ROOF grafts, and 38 received orbicularis oculi muscle flaps. This technique converted a static fold into a dynamic fold. The surgery had a satisfaction rate of 86.7%. Complications included partial fold loss (n=7, 3.4%), complete fold loss (n=3, 1.5%), sunken upper eyelids (n=5, 2.5%), multiple folds (n=3, 1.5%), an unnatural curve of the double fold (n=5, 2.5%), and asymmetric folds (n=4, 2.0%). Conclusions To convert a static fold to a dynamic fold, we devised a technique that releases adhesion of the lower flap and reconstructs the PTD with ROOF graft or an orbicularis oculi muscle flap. Our study achieved a high patient satisfaction rate, and the resulting fold mimicked the dynamics of the congenital double-eyelid fold.

Tarsus-Orbicularis-Septum Fixation in Double-Eyelid Blepharoplasty: A Reliable and Flexible Technique

“… 10 However, too much resection of pretarsal tissue can cause a depressed scar and a static fold, which need revision. 4 A modified technique called the orbicularis-tarsus fixation approach was proposed, which was similar to the classic method, but the pretarsal fascia and pretarsal orbicularis oculi muscle are preserved. 11 …”

“…The ideal outcome after double eyelidplasty is creating a long-lasting dynamic upper eyelid fold with suitable height and depth without a visible scar or hollow appearance when the eyes are closed or gazing down. 4 Compared with nonincisional techniques, incisional double eyelid blepharoplasty is more widely performed. The classic incisional technique involves overresection of pretarsal tissue and dermis-tarsus fixation, which usually creates a static fold.…”

“…The classic incisional technique involves overresection of pretarsal tissue and dermis-tarsus fixation, which usually creates a static fold. 4 , 5 The features of a static fold include deep fold formation when the eye is open and a still, sunken line in the previous incision when the eye is closed or looking downward. 3 Dynamic double eyelids can be created with flexible tissues such as orbicularis-levator fixation, 6 septoaponeurosis junctional thickening (SAJT), 3 and septal extension.…”

Orbicularis-Tarsus-Orbital Septum Fixation Technique in Asian Double-Eyelid Blepharoplasty: a Retrospective Study

“…But static folds or even depressed scars usually occur for too much pretarsal tissue resection. 11 As to orbicularis-levator aponeurosis fixation, dynamic folds can be achieved because of the reservation of pretarsal soft tissue. However, the problem of postoperative relapse is quite common and the symmetry of bilateral folds is more technical.…”

“…When using the classic skin-tarsus-skin fixation, the crease height is easy to adjust and the created adhesion is stable. But static folds or even depressed scars usually occur for too much pretarsal tissue resection 11. As to orbicularis-levator aponeurosis fixation, dynamic folds can be achieved because of the reservation of pretarsal soft tissue.…”