Revision Asian Upper Eyelid Surgery (Blepharoplasty)

Before

After

In my 15 years experience performing Asian upper eyelid surgery, also called blepharoplasty, I have seen a significant number of cases in which the procedures have not been performed appropriately.  This usually results in eyelids with one of the following scenarios:

1. Folds that are smaller completely hidden that are not in accordance with the patient’s wishes (although some specifically request hidden or thin folds),
2. Folds that are abnormal in shape with a reverse taper fold (the inner portion of the fold is larger then the outer portion),
3. Folds with significant asymmetry,
4. Folds that are too large and out of proportion with the patient’s eyes.

Among these frequently seen unfavorable outcomes, the first 3 are usually easy to revise.  The cases where the folds are too large present the most challenging situation.  In the past, most of these patients had to be content with minimal correction or no correction at all.

As I have dealt with significant number of these patients, I have developed a technique that can usually correct significant number of these cases.  Using a combination of fat replacement and fold repositioning, I have been able to revise many of these patients’ eyes, even those who have been previously told that there is no possible correction for their eyelids.

The technique involves lowering the previous incision lines.  This step is usually easily done but when performed by itself, it usually results in a very high incidence of failure due to the reattachment of the scar from the previous incision.  Imagine the previous incision scar like 2 pieces of tape stuck together.  One side of the tape represents the eyelid skin, the other side the muscle that opens and closes the eye (the Levator muscle).  When the muscle contracts, the attachment between the muscle and the skin creates a traction along the scar forming the folds.  Now imagine taking the attachment apart but allowing them to be next to each other.  The stickiness of the scar, like the stickiness of the tape, will cause the 2 sides to stick back together recreating the previous fold.

In order to avoid this recurrence, it is essential that a barrier be created between the 2 sides.  This is the function of the fat transfer.  Fat is usually harvested from the patient’s lower abdomen and placed along the previous scar to prevent the reattachment.  Many patients have questioned whether the fat will survive the transfer.  In my experience fat transfer to the various parts of the face have a very high survival rate.  Even in rare cases in which the fat doesn’t remain in significant amount, the time that elapses between the transfer to the loss of significant portion of the fat would have allowed the new fold to develop in the new position, overcoming the tendency of the previous folds to reform.

Using this technique, significant number with previously uncorrectable post-surgical upper eyelid deformities can be revised to create a more aesthetic upper eyelid fold.