Revision upper blepharoplasty: correcting upper eyelid retraction after initial upper blepharoplasty

Objective To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation. Methods A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision. Results All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2 cases (6%) recurred upper eyelid retraction in 3 months after operation, while the other 28 cases (85%) showed satisfactory results. Conclusions The upper eyelid tendon membrane and Muller′s muscle compound tissue turnover flap extension is helpful to correct the upper eyelid retraction, caused by blepharoplasty. Key words: Retraction of upper eyelid; Repair; Double eyelid plasty