Lowering of the High Eyelid Crease in Revision Upper Eyelid Surgery.

BACKGROUND: High placement of the lid crease is a common complication in upper eyelid surgery. Correction of the high crease by revision surgery is challenging and has not been well-reported. METHODS: This is a retrospective interventional study of patients who underwent revision eyelid surgery with lowering of the lid crease from 2008 to 2016 at a tertiary institution. Main outcome measures were pretarsal show (PTS) distance, lid crease symmetry, margin reflex distance 1 (MRD1), and lid height symmetry. Lid crease symmetry was graded as symmetrical, mild asymmetry (PTS difference ≤ 0.5 mm), moderate asymmetry (PTS difference > 0.5 mm but ≤ 1 mm), or obvious asymmetry (PTS difference > 1 mm). Lid height symmetry was graded as symmetrical, mild asymmetry (MRD1 difference ≤ 1 mm), moderate asymmetry (MRD1 difference > 1 mm but ≤ 2 mm), or obvious asymmetry (MRD1 difference > 2 mm). RESULTS: There were a total of 69 patients and 100 eyes. The majority (n = 42, 60.9%) of patients were females. The mean age was 38.3 ± 17.3 years, and mean follow-up was 16 months. Mean PTS decreased from 3.1 mm pre-surgery to 2.0 mm 2 years post-surgery. The proportion of patients with moderate or severe lid crease asymmetry decreased from 81.1% pre-surgery to 6.7% 2 years post-surgery. The mean MRD1 difference decreased from 1.54 mm pre-surgery to 0.23 mm 1 year post-surgery. The proportion of patients with moderate or severe lid height asymmetry improved from 64.5% preoperatively to 4.5% 1 year postoperatively. CONCLUSION: Revision eyelid surgery to correct a high crease is a challenging procedure. We present a technique that is effective in correcting the high lid crease, while simultaneously improving the lid height and lid crease symmetry. 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 .

Secondary Blepharoplasty: Correction of the High Fold.

BACKGROUND: Blepharoplasty is a common aesthetic surgery performed worldwide. In Asians, too high eyelid folds after blepharoplasty cause an unsatisfactory aesthetic outcome that is difficult to correct. In this article, the authors propose surgical techniques to correct the high eyelid fold after blepharoplasty. METHODS: During a 4-year period, 213 secondary blepharoplasties were performed to correct high folds. Postoperative results were reviewed, graded, and analyzed. RESULTS: Of 213 cases of secondary blepharoplasty to correct the high eyelid fold, almost all could achieve reduction of the fold size (98.59 %). One hundred and nine cases (51.17 %), 69 cases (32.40 %), and 32 cases (15.02 %) were classified as excellent, good, and fair results, respectively. Only three cases (1.41 %) were classified as poor results. CONCLUSION: Secondary blepharoplasty to correct a high fold is a challenging procedure for aesthetic surgeons. Surgeons performing this operation need to have a thorough understanding of eyelid anatomy and its dynamics together with familiarity with secondary blepharoplasty to avoid any further injury to the levator muscle. The key points of this surgery are levator advancement and intervening between the levator aponeurosis and the overlying skin by in situ tissue or fat grafting. LEVEL OF EVIDENCE V: This journal requires the authors to 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 .

Upper blepharoplasty revision technique: Correction of the high eyelid fold using the pretarsal orbicularis oculi flap.

PURPOSE: With the growing popularity of upper lid blepharoplasty, there have been increasing reports of unsatisfactory outcomes that have necessitated a revision surgery. This study aimed to evaluate aesthetic outcomes of surgical correction of the high eyelid fold using a pretarsal orbicularis oculi flap and to highlight the key practice points of this surgical procedure in secondary blepharoplasty. METHODS: A retrospective study of 31 consecutive Chinese patients who underwent revision surgeries between January 2013 and December 2015 was undertaken through a review of medical records. All these patients underwent surgical correction of high eyelid folds using a pretarsal orbicularis oculi flap, with postoperative follow-up ranging from 6 months to 4 years. Postoperative outcomes were reviewed, evaluated, and analyzed. RESULTS: In this study of 31 women who underwent secondary revision procedure of the high eyelid fold using a pretarsal orbicularis oculi muscle flap, mean follow-up time was 8.2 (range 6-48) months. All flaps survived without significant complications. There was no reported incidence of hematoma or infection in early postoperative complications. Clinical effectiveness was satisfactory in most of the patients who underwent fold repair (26/31, 83.9%). However, five patients (16.1%) expressed dissatisfaction with postoperative outcomes; of them, four patients (12.9%) had mild asymmetry, whereas surgical revision was required in only one patient (3.2%). CONCLUSION: Secondary blepharoplasty to correct the high eyelid fold is a challenging procedure for plastic surgeons. Use of the pretarsal orbicularis oculi muscle flap for correction of the high eyelid fold is safe and effective, with better biomechanics and a satisfying aesthetic outcome. This provides a novel treatment option in limited secondary revision techniques.

Revision Upper Blepharoplasty.

The ideal shape and height of the double eyelid varies widely depending on the patient and the culture. Patients may be dissatisfied after a double eyelid operation for the following reasons: scar, low versus high fold, shallow versus deep fold, triple folds, pretarsal fullness, ptosis, and asymmetry. Here the author describes the complications experienced after double eyelid surgery and corrective procedures.