Subciliary Augmentation of the Lower Eyelid in Asians Using a Deep Temporal Fascia Graft: A Preliminary Report

Abstract

Background

Pretarsal fullness of the lower eyelid has recently gained popularity in the Asian population. Hyaluronic acid injection is a simple, nonsurgical method for creating pretarsal fullness of the lower eyelid, but the effects last only 6–12 months. A need exists for a surgical procedure with long-term effects. We describe the use of a deep temporal fascia graft for subciliary augmentation of the lower eyelid.

Methods

Between September 2009 and October 2011, seven Japanese patients underwent subciliary augmentation of the lower eyelid. This retrospective study was conducted on four of the seven patients who were followed for more than 1 year. A skin incision of approximately 1 cm was made at the lateral canthus along the subciliary crease of the lower eyelid and the skin was undermined to create a subcutaneous tunnel. A stab incision was then made 2 mm below the ciliary margin near the level of the lower lacrimal punctum. The orbicularis oculi muscle was incised under the skin incision at the lateral canthus, and the stump of the incised muscle was suspended to the periosteum of the lateral orbital rim. A deep temporal fascia graft was placed in the undermined subcutaneous plane of the lower eyelid.

Results

Lower-eyelid pretarsal fullness was maintained at more than 1 year after surgery. The eyelids regained a natural appearance, and the patients were highly satisfied. Morphometric measurements demonstrated increased projection and width of the lower-eyelid pretarsal fullness.

Conclusions

Deep temporal fascia grafting is safe and reliable for subciliary augmentation of the lower eyelid.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.