Preaponeurotic Fat Advancement for Prevention of Unexpected Higher Eyelid Crease in Upper Eyelid-Lengthening Surgery

Abstract

Purpose: To present a modified technique based on preaponeurotic fat advancement for preventing higher eyelid crease in upper eyelid-lengthening surgery.

Methods: Outcomes of Japanese patients with Graves’ orbitopathy-related upper eyelid retraction who underwent transcutaneous upper eyelid-lengthening surgery were reviewed. The minimum follow-up period was 6 months. A total of 17 upper eyelids in 11 patients (average age, 38.4 years) were included. After confirming appropriate upper eyelid lowering with good contour, preaponeurotic fat was fully exposed and fixed on the upper tarsal plate 1 mm superior to the planned eyelid crease with 5 sutures. Skin-tarsus-skin sutures were placed to create an eyelid crease and close the skin. Simple suture tarsorrhaphy was performed with 2 sutures.

Results: No upper eyelids demonstrated higher eyelid crease postsurgically. Upper eyelid fullness caused by the advanced preaponeurotic fat was not conspicuous.

Conclusions: Our technique is a countermeasure against higher eyelid crease in upper eyelid-lengthening surgery.

KEYWORDS::

• Preaponeurotic fat advancement
• Higher eyelid crease
• Upper eyelid lengthening surgery
• Graves’ orbitopathy
• Upper eyelid retraction

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.