Abstract
Background
Incisional double-eyelid blepharoplasty is the main surgical technique to obtain an artificial crease. Postoperative complications decrease patients’ satisfaction, and patients with prominent depressed groove and persistent pretarsal swelling (sausage phenomenon) usually need revision surgery. To resolve the sausage phenomenon after blepharoplasty, we adopt Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach to create natural double eyelids.
Methods
We included 68 patients in the study. The inclusion criteria for revision surgery were as follows: (1) pretarsal OOM remained after primary surgery, (2) prominent depressed surgical scar/groove and persistent pretarsal bulge (sausage phenomenon), (3) postsurgical abnormally wide crease. The surgical procedure involved releasing the pretarsal OOM, forming OFOOM-OOM flap, and OFOOM-OOM flap fixed with aponeurosis. Outcome observations were assessed using the FACE-Q questionnaire, and the follow-up period ranged from 6 to 36 months (mean=18 months).
Results
The depressed groove and pretarsal bulge showed significant improvements, and FACE-Q scores of the 68 patients before surgery (mean scores=66) compared with those after surgery (mean scores=90) were significantly different (P<0.01). Four patients with palpebral fold asymmetry and two patients with shallow eyelids received revision surgery, and patients were satisfied with the secondary surgery effects. Six patients presented with unnatural curves of folds and revision surgery alleviated these situations.
Conclusions
Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach is an effective way to resolve the sausage phenomenon. The OFOOM-OOM flap is a reliable and flexible structure to create natural double eyelids.
Level of Evidence IV
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.
Similar content being viewed by others
References
Saonanon P (2014) Update on Asian eyelid anatomy and clinical relevance. Curr Opin Ophthalmol 255:436–442
Gu T, Wang Y, Chen W (2020) Comparison of palpebral marginal and traditional incision techniques for double-eyelid surgery. Aesthet Plast Surg 443:799–807
Yang CC (2023) Revision of Asian upper blepharoplasty. Clin Plast Surg 501:111–120
Morikawa K, Yamamoto H, Uchinuma E, Yamashina S (2001) Scanning electron microscopic study on double and single eyelids in orientals. Aesthet Plast Surg 251:20–24
Jeong S, Lemke BN, Dortzbach RK, Park YG, Kang HK (1999) The Asian upper eyelid: an anatomical study with comparison to the caucasian eyelid. Arch Ophthalmol 1177:907–912
McCurdy JA, Jr. (2005) Upper blepharoplasty in the Asian patient: the “double eyelid” operation. Facial Plast Surg Clin North Am 131:47–64
Sun W, Wang Y, Song T, Wu D, Li H, Yin N (2018) Orbicularis-tarsus fixation approach in double-eyelid blepharoplasty: a modification of park’s technique. Aesthet Plast Surg 426:1582–1590
Park JI (1999) Orbicularis-levator fixation in double-eyelid operation. Arch Facial Plast Surg 12:90–95 (discussion 96)
Choi Y, Eo S (2016) Outer fascia of orbicularis oculi muscle as an anchoring target tissue in double eyelid surgery. J Craniofac Surg 272:322–327
Gama JT, Rossetto LA, Brito NB, Veiga DF, Ferreira LM (2020) Cross-cultural validation of the FACE-Q Satisfaction with facial appearance overall scale (FACE-Q SFAOS) in Brazilian rhytidoplasty patients. Clinics (Sao Paulo) 75:e1568
Chen B, Song H, Gao Q, Xu M, Wang J, Wang F, Chen S, Wu J, Li H (2017) Measuring satisfaction with appearance: validation of the FACE-Q scales for double-eyelid blepharoplasty with minor incision in young Asians- retrospective study of 200 cases. J Plast Reconstr Aesthet Surg 708:1129–1135
Sayoc BT (1956) Absence of superior palpebral fold in slit eyes; an anatomic and physiologic explanation. Am J Ophthalmol 422:298–300
Kakizaki H, Madge SN, Selva D (2010) Insertion of the levator aponeurosis and Muller’s muscle on the tarsus: a cadaveric study in Caucasians. Clin Exp Ophthalmol 386:635–637
Kakizaki H, Madge SN, Malhotra R, Selva D (2009) The levator aponeurosis contains smooth muscle fibers: new findings in Caucasians. Ophthalmic Plast Reconstr Surg 254:267–269
Park JI, Park MS (2007) Double-eyelid operation: orbicularis oculi-levator aponeurosis fixation technique. Facial Plast Surg Clin North Am 153:315–326
Hollander MHJ, Schortinghuis J, Vissink A, Jansma J, Schepers RH (2020) Aesthetic outcomes of upper eyelid blepharoplasty: a systematic review. Int J Oral Maxillofac Surg 496:750–764
Cho IC (2015) Revision upper blepharoplasty. Semin Plast Surg 293:201–208
Gradinger GP (1988) Cosmetic upper blepharoplasty. Clin Plast Surg 152:289–297
Hoorntje LE, Lei B, Stollenwerck GA, Kon M (2010) Resecting orbicularis oculi muscle in upper eyelid blepharoplasty–a review of the literature. J Plast Reconstr Aesthet Surg 635:787–792
Funding
This study did not receive funding from any funding agency.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
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 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent and permission to use photographs were obtained from patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zhou, L., Liu, L., Yang, J. et al. Outer Fascia of Orbicularis Oculi Muscle (OFOOM)-Orbicularis (OOM)-Aponeurosis Fixation Approach in Double-Eyelid Blepharoplasty Revision. Aesth Plast Surg 48, 835–841 (2024). https://doi.org/10.1007/s00266-023-03731-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-023-03731-2