Correction of Superior Sulcus Deformity With Orbital Fat Anatomic Repositioning and Fat Graft Applied to Retro-Orbicularis Oculi Fat for Asian Eyelids

Background “Sunken eyelid” is a term used to describe a deeply sunken area between the upper eyelid and upper edge of the orbital bone. The condition frequently is accompanied by blepharoptosis. Correction of a “sunken eyelid” generally is performed with a fat graft. However, surgical limitations such as a movement dysfunction of the upper eyelid or irregular skin surface often are encountered using the grafting method previously reported. An open technique is believed to be more precise than a closed procedure, and satisfactory results may be achieved by repositioning the upper eyelid fat and applying a fat graft to the retro-orbicularis orbital fat (ROOF). Methods Fat was harvested from the medial thigh area using a 10-ml syringe with minimal pressure. During the upper eyelid surgery, the orbital fat was relocated between the conjoined tendon of the levator aponeurosis and the lower orbicularis oculi muscle and skin flap. The ROOF was verified, and fat grafting then was performed from the upper medial side to the lower lateral side and from the medial aspect to the lateral direction using an 18-gauge Coleman needle. The sunken eyelids were classified into grades 1 to 4 according to the sunken depth (i.e., the distance between the most inferior orbital rim and the site of the most sunken area). The amount of fat graft and the technique of incorporating the fat were different according to sunken depth. Results From January 2006 to June 2008, 50 Korean and Chinese patients (48 women and 2 men) underwent fat repositioning and ROOF fat grafting using an open technique. The patients ranged in age from 24 to 67 years. The mean observation period was 4.7 months. The amount of fat graft for each palpebra was 0.3 to 3.3 ml, and the mean graft amount was 1.4 ml. Satisfactory results were obtained for most of the patients, but four patients required additional surgery. The reasons for the secondary surgery were a translocation of the fat graft to a lower position forming a lump (2 patients) and undercorrection (2 patients). The rate of fat absorption was relatively low and the complications very few compared with surgical cases involving a noninvasive method. Conclusions More precise treatment is possible by dividing the depressed area of the upper eyelid according to the stage. Satisfactory results were achieved by relocating the orbital fat using an open method and adjusting the ROOF fat graft according to the stage.