Correction of High Eyelid Folds Using Three-Plane Dissection and Fat Repositioning/Grafting in Revisional Blepharoplasty.

[BACKGROUND] The deformity of high eyelid fold is a common complication of Asian blepharoplasty, and its correction remains a significant challenge in clinical practice. Our study introduced a refined technique for the correction of high eyelid folds and aimed to evaluate the efficacy and safety of this technique.

[METHODS] This was a retrospective study, and a total of 90 patients with high eyelid folds were included. During surgery, a three-plane dissection was performed above the incision line to completely release the tension caused by scar adhesion. Preaponeurotic fat flap repositioning or autologous abdominal fat grafting was conducted to prevent scar readhesion of the eyelid tissue and recurrence of high folds. After a minimum of six-month follow-up, the postoperative outcome including patient satisfaction and complications was analyzed.

[RESULTS] The mean postoperative height of the double eyelid crease was 7.1 mm, significantly reduced compared to the preoperative height (7.1 ± 0.3 mm vs 11.1 ± 0.5 mm, P < 0.01). In our study, the overall satisfaction rate was 87.8%, with 29 patients (32.2%) reporting being very satisfied and 50 patients (55.6%) satisfied. Among the 11 patients (12.2%) dissatisfied with the postoperative outcomes, four patients had recurrent or persistent high folds, three patients had asymmetric folds, two patients still had eyelid depression, and two patients had lagophthalmos. Furthermore, logistic regression analysis showed that surgical history of blepharoplasty (P = 0.002), concomitant blepharoptosis (P = 0.031), and concomitant eyelid depression (P = 0.005) were the independent predictors of the patient satisfaction.

[CONCLUSION] This technique, involving three-plane dissection combined with fat repositioning or grafting, has been shown to be effective with high patient satisfaction and safe with a low complication rate for correcting high lid folds. Our study provides an optional surgical procedure for revisional blepharoplasty, but further studies are needed to evaluate its application in a broader population.

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