Local retro-orbicularis oculus fat (ROOF) resection in upper blepharoplasty: A retrospective evaluation study of 65 bilateral upper blepharoplasties

Puffy upper eyelids are normal in Asians, and full-incision blepharoplasty is commonly performed to remove some orbital fat to ameliorate the problem, but not all patients would exhibit obvious improvement. Local retro-orbicularis oculus fat (ROOF) is a layer of fibrofatty soft tissue that lies much deep into the orbicularis oculi in the upper eyelid, which is an important factor in the formation of puffy upper eyelids. This study was carried out to evaluate the clinical application (including the evaluation of photographs for the thickness of upper eyelid) of upper blepharoplasty combined with ROOF resection for correcting puffy upper eyelids. A total of 65 patients (5 males, 60 females) with puffy upper eyelids recruited from October 2015 to October 2016 were included in the study. Full-incision blepharoplasty combined with partial ROOF resection was performed on all patients. The thickness of soft tissue in the upper eyelid was measured by ultrasound biomicroscopy preoperatively and at 12 months postoperatively. All patients underwent surgery successfully, and 62 patients (124 eyes) were followed up for 12–15 months (mean 13.8 ± 2.7 months). Before the surgery, the thickness of the ROOF was 0.35 ± 0.12 mm on the left and 0.42 ± 0.08 mm on the right. Twelve months postsurgery, the thickness of the ROOF was 0.18 ± 0.03 mm on the left and 0.20 ± 0.02 mm on the right. During the follow-up period, all patients were satisfied with the esthetic effect, and no severe postoperative complications were observed. Puffy upper eyelids can be corrected effectively by local ROOF resection in esthetic blepharoplasty.