Upper blepharoplasty revision technique: Correction of the high fold using the pretarsal orbicularis oculi flap

Publication date: Available online 24 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Hai-Peng Liu, Ying Shao, Bing Li, Meng-Ru Sun, Xiao-Jie Yu, Duo Zhang

Summary

Purpose

With the growing popularity of upper lid blepharoplasty, there have been increasing reports of unsatisfactory outcomes that have necessitated a revision surgery. This study aimed to evaluate aesthetic outcomes of surgical correction of the high fold using a pretarsal orbicularis oculi flap, and to highlight the key practice points of this surgical procedure in secondary blepharoplasty.

Methods

A retrospective study of 31 consecutive Chinese patients who underwent revision surgeries between January 2013 and December 2015 was undertaken through a review of medical records. All of these patients underwent surgical correction of high folds using a pretarsal orbicularis oculi flap, with postoperative follow-up ranging from 6 months to 4 years. Postoperative outcomes were reviewed, evaluated, and analyzed.

Results

In this study of 31 women who underwent secondary revision procedure of the high eyelid fold using a pretarsal orbicularis oculi muscle flap, mean follow-up time was 8.2 (range 6–48) months. All flaps survived without significant complications. There was no reported incidence of hematoma or infection in early postoperative complications. Clinical effectiveness was satisfactory in most of patients who underwent fold repair (26/31, 83.9%). However, 5 patients (16.1%) expressed dissatisfaction with postoperative outcomes; of these, 4 patients (12.9%) had mild asymmetry, whereas surgical revision was required in only 1 patient (3.2%).

Conclusion

Secondary blepharoplasty to correct the high fold is a challenging procedure for plastic surgeons. Use of the pretarsal orbicularis oculi muscle flap for correction of the high fold is safe and effective, with better biomechanics and a satisfying aesthetic outcome. This provides a novel treatment option in limited secondary revision techniques.