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Correction of Sunken Upper Eyelid in Asian Blepharoplasty Based on Anatomical and Histological Study of Orbital Fat Fascia Flap

  • Original Articles
  • Oculoplastic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Objectives

To explore the clinical application of orbital fat fascia flap in the correction of sunken upper eyelid in Asian blepharoplasty based on anatomical and histological research.

Methods

Observe the histological structure of the orbital fat and its fascia vascularity through cadaver anatomy and histological sections of 10 cadavers. Based on the anatomical and histological characteristics of orbital fat, 36 patients with mild to moderate sunken upper eyelids were corrected by transposition of orbital fat fascia flap with preservation of fascia vascular pedicle. During the operation, the lateral part of the central cellulite of orbital fat was separated longitudinally and transferred to the sunken place to correct the sunken upper eyelid.

Results

Anatomy and histology show that the orbital fat was located between the anterior layer of the levator aponeurosis and the posterior layer of the orbital septum and was separated into fat lobules by many fibrous septa. The blood vessels move forward from back to front along the orbital fat interlobular septum, and the blood vessels in the capsule below the orbital fat are abundant. Clinical results showed that the shape of the sunken upper eyelid was significantly improved in 35 cases after correction with this method during the postoperative follow-up from 9 months to 18 months. The mean sunken depth improved from 6.2mm (±1.0 mm) preoperatively to 2.2mm (±0.9 mm) at the last follow-up with a statistical significance. And only 1 case had partial depression in the unilateral eyelid and received autologous granular fat transplantation with satisfactory postoperative results.

Conclusion

The transposition of orbital fat fascia flap with longitudinal separation and preservation of fascia vascular pedicle can better correct the sunken upper eyelid during blepharoplasty, and the long-term effect is stable, which is worthy of clinical promotion.

Level of Evidence IV

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Funding

None declared.

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Author notes

  1. Shenzhen Gao and Min Yi have the equally contribution to this work and they should be considered as co-first authors.

Authors and Affiliations

  1. Department of Plastic and Cosmetic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146, Han-zhong Road, Nanjing, 210029, Jiangsu, China

    Shenzhen Gao, Min Yi, Changhao Li, Baixue Lu & Weicheng Gao

Authors
  1. Shenzhen Gao
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  2. Min Yi
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  3. Changhao Li
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  4. Baixue Lu
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  5. Weicheng Gao
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Contributions

Conceptualization: WG, SG. Writing—original draft: SG, BL. Methodology: MY, CL. Writing—review & editing: WG.

Corresponding author

Correspondence to Weicheng Gao.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, informed consent is not required, but patients provided informed consent for using their images before the operation.

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Gao, S., Yi, M., Li, C. et al. Correction of Sunken Upper Eyelid in Asian Blepharoplasty Based on Anatomical and Histological Study of Orbital Fat Fascia Flap. Aesth Plast Surg 48, 134–140 (2024). https://doi.org/10.1007/s00266-023-03537-2

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  • DOI: https://doi.org/10.1007/s00266-023-03537-2

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