A Novel Preoperative Design Utilizing the Rouleau Phenomenon for Sunken Eyelids.

[BACKGROUND] Correcting sunken eyelids is challenging. This is because the eyelid skin easily moves according to orbital fat volume, making it difficult to predict, which can lead to asymmetrical or unfavorable results. Currently, the preoperative design method for understanding the Rouleau phenomenon and using it to push the lower bag can be helpful as it reduces asymmetry and offers greater predictability. The current study shares our experiences of sunken eyelid correction either by combined upper blepharoplasty and micro-fat grafting. We also introduce our unique preoperative design utilizing the Rouleau phenomenon.

[METHODS] This study included 60 patients who underwent upper blepharoplasty with a fat graft to correct sunken eyelids. It is a retrospective review of 60 cases from August 2021 to April 2023.

[RESULTS] This study included sixty patients who underwent fat grafting (FG) for sunken eyelid correction and/or upper blepharoplasty (UB) between August 2021 and April 2023. There were nine cases (15%) in which only FG was performed without the need for UB, and 43 cases (71.7%) involved patients who underwent both UB and FG together and achieved aesthetic satisfaction after only one surgery. Revisional surgery was performed when the results were unsatisfactory after the first surgery, which included persistently visible wrinkles, sunken undercorrection, and palpable lumps.

[CONCLUSIONS] We successfully corrected sunken eyelids in the Asian population with a customized approach using fat grafting and/or upper blepharoplasty based on our unique preoperative design utilizing the Rouleau phenomenon. This will assist plastic surgeons in achieving a better aesthetic outcome in this challenging area.

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