RESUMEN
Objective:To explore the soft tissue composition underlying upper eyelid puffiness and the experience in treating it with tailor-made procedure during upper blepharoplasty.Methods:In a retrospective study from January 2017 to December 2018, 165 patients with upper eyelid puffiness underwent full-incision upper blepharoplasty. During the procedure, the anterior wall of orbital septum was exposed, and the volume of the retro-orbicularis oculus fat (ROOF) and preaponeurotic fat was observed. The orbital septum would be opened if lacrimal gland prolapse was suspected. The puffy upper eyelid would be targeted with tailor-made procedure such as partial ROOF resection, removal or transposition of the preaponeurotic fat, as well as lacrimal gland refixation.Results:All 165 cases were healed by first intention. No relapse was found after a 6 to 24 months follow-up. Persistent mild pain and local skin tightness epiphora chemosis were presented in isolated cases with self-resolution within a short time. There were no severe adverse reaction or complications occurred during the operation and follow-up.Conclusions:The tailor-made procedure during upper blepharoplasty targets the soft tissue anatomy underlying upper eyelid puffiness. It is safe and effective in maintaining a natural look of upper eyelids while retaining the appropriate amount of adipose tissue in the upper eyelid.