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

Background: Abnormally high eyelid fold is a common unsatisfactory esthetic outcome after double eyelid surgery. At present, successful correction of high eyelid fold among Asians remains one of the most challenging procedures for eyelid plastic surgeons. Objectives: This article aims to propose a novel technique for correcting high eyelid fold to improve the cosmetic outcomes and patient satisfaction. Materials and Methods: This is a retrospective study of 86 patients (154 eyelids) with high eyelid folds who underwent revision blepharoplasty. A new proper height incision line was designed during the operation, and the adhesion between skin and levator aponeurosis was fully released. The residual orbital fat was adequately separated. If necessary, orbital fat from lower eyelid will be harvested for free fat grafting. The tarsus-orbicularis fixation combined with orbital fat repositioning technique was used to create a double eyelid fold and reconstruct the gliding zone. The surgical outcome and patient satisfaction are reviewed. Results: Among the 154 eyelids with high eyelid fold, mean lid crease height decreased from 9.8 mm preoperation to 6.8 mm ( P <0.001) and mean pretarsal show decreased from 3.5 mm preoperation to 1.9 mm 6 months postoperation ( P <0.001). The esthetic outcome was fully satisfied in 78 patients (90.7%) and basically satisfied in 6 patients (7.0%). Two patients (2.3%) were unsatisfied because of ptosis undercorrection in 1 patient and asymmetry in the other. They both got satisfied results after reoperation. Conclusions: The tarsus-orbicularis fixation combined orbital fat repositioning technique is a simple and effective method to correct high eyelid folds with high satisfaction and rare complications.