Correction of Sunken and/or Multiple Folded Upper Eyelid by Refined Structural Micro-Fat Graft: Technical Pearls

Structural micro-fat graft is one of the surgical techniques for facial rejuvenation, and it is reliable for correction of sunken upper eyelids especially. However, several factors may influence surgical outcomes substancially. The author introduces the modified micro-fat graft to correct sunken eyelids and multiple eyelid folds to make better results. A series of 162 patients who underwent the refined structural micro-fat graft were included in this study. The purified fat was injected into the subcutaneous and sub-orbicularis oculi muscle layer of the upper eyelids through the 19-gauge cannula with 1 ml syringe. After the operation, all patients were followed up on 2 weeks, 1 month, 3 months, 6months, and 1 year. Clinical photographs were taken every visit and the author evaluated the volume and symmetry of the eyelids and checked the satisfaction of each patient and any complications. Among the 162 patients, 156 patients were satisfied with the upper eyelid volume after primary fat graft and other 6 patients were performed secondary fat graft. Even though the volume of the fat was sufficient, 4 patients showed palpable fat nodule during the follow-up period. Modified micro-fat graft is a simple, safe, and alternative method to correct sunken eyelids and multiple eyelid folds.

Correction of Sunken Upper Eyelids Using Incisional Double Eyelidplasty and Autologous Microfat Grafting into Orbital Septum

Sunken upper eyelids are one of the common and complicated problems that occur with an aging process or after double eyelidplasty. Autologous microfat grafting is a technique that has frequently been used for sunken eyelids. The traditional blind method of microfat grafting has a some complications. Therefore, we performed the open method with incisional double eyelidplasty. Between June, 2005 and February, 2008, we performed incisional double eyelidplasty and autologous microfat grafting into orbital septum in 63 patients(124 cases) with sunken upper eyelids. The fat was harvested from periumbilical regionand centrifuged at 3000 rpm for 3 minutes. After the middle fat layer was obtained by 1cc syringe, we made skin incision and separated orbital septum(inner layer) and levator aponeurosis. And then, we injected the microfat into orbital septum with 0.9 mm blunt cannula. At this time, one of the important things was to make the patient gaze upward during the fat injection. All the patients were satisfied, except 5 cases which were 3 cases of undercorrection and 2 cases of asymmetry. Surgical revision was required for only the above 5 cases(4%). Patients with some transient complications of ptosis (13 cases), overcorrection(4 cases) and nodular appearance(2 cases) were self-improved. We found that the method using incisional double eyelidplasty and autologous microfat grafting into orbital septum has many advantages which include less traumatic, less complication rate, less absorption rate of fat. and less burden of patients.

Correction of Sunken Eyelid with Unfavorable Fold Using Autologous Fat Injection

PURPOSE: Sunken eyelid is a deformity of upper eyelid due to atrophy of periocular fat tissue, loss of skin elasticity. It causes the skin retraction of eyelid and unfavorable fold. Sunken eyelid occurs from the results of natural aging process, facial trauma, complication of previous periocular surgery, etc. We acquired a satisfied correction of sunken eyelid and unfavorable fold using autologous fat injection only. The aim of this study is a assessment of autologous fat injection for correction of sunken eyelid accompanied with unfavorable fold. METHODS: From August 2002 to March 2006, we performed 37 cases of correction of sunken eyelid with unfavorable fold using autologous fat injection. They were all females with ages ranged from 23 to 63. Fat was harvested from lower abdomen and centrifuged with Coleman system. Multi-layered injection of purified fat was done from orbital fat layer to orbicularis oculi muscle. RESULTS: Overall, improvement of sunken eye and unfavorable fold was observed in the majority of the patients. Discomfort of eye opening was improved in 24 patients. The average injection volume was 1.33mL in right eyelid, 1.31mL in left eyelid at first injection. Second injection was done in patients who absorption of injected fat was noted with. No specific complications were observed. CONCLUSION: Natural and attractive upper eyelid was acquired from fat injection only in sunken eyelid with unfavorable fold. To the authors' knowledge, it is desirable for sunken eyelid accompanied with unfavorable fold to be treated with autologous fat injection at first. Although some shortcomings are substantial, autologous fat injection is easy and effective method for correction of unfavorable fold in sunken eyelid without specific complication.

Correction of Sunken upper Eyelids Using Autologous Microfat Graft

The amount of the soft tissue of upper eyelids is aesthetically important. The soft tissue of thick eyelids need to be removed, whereas the sunken eyelids need to be augmented. The sunken eyelids make someone look older and more tired. The aesthetical use of the autologous fat has been advocated for tissue augmentation for over a century and microfat graft is a popular procedure to augment the soft tissue. We had corrected the sunken eyelids of 11 patients without any history of aesthetical surgery or trauma of upper eyelids using autologous microfat graft. The fat had been harvested from periumbilical area, centrifuged at 3000rpm for 3 minutes. The middle fat tissue layer was obtained using 1cc syringe and injected in the upper eyelids. All procedures were performed under local anesthesia. There were no major complications except undercorrection in two cases. Though survival rate of injected microfat is variable, it is predictable in upper eyelid compare to other areas. As a result, autologous microfat graft should be considered as a good choice for correction of sunken eyelids.