Brow fat pad flap transfer for repairing depressed deformity of the upper eyelids

To study the new surgical approach to repair depressed deformity of the upper eyelids by transferring brow fat pad flap that retains blood supply and similar construction with the orbital septum.

An incision was made in the inferior margin of the brow to dissect and expose the brow fat pad under the orbicular muscle of the eye and frontal muscle plane in the lateral superior orbit, and the flap was removed from above the periosteum and pedicled under the orbital rim. Through the incision in the double-eyelid fold, a tunnel was dissected upward from the plane under the orbicular muscle to reach the brow incision. The brow fat pad flap was then turned over to cover the deformity, followed by fixation and suture of the flap and a double-eyelid operation.

Four patients with the upper eyelid deformity were successfully treated using this new procedure with satisfactory results and no complications were encountered. Fat absorption was not observed in the one-year follow-up.

This procedure has the merits that (1) the fat tissue transferred to the recipient site has blood supply, thus fat absorption is prevented and the surgical results can be almost permanently maintained; (2) The similarity between the construction of the brow fat pad and the orbital septum fat may ensure better result with more natural look of the eyelids; (3) The donor site is adjacent to the recipient site to facilitate the brow fat pad transferring; (4) The operation leaves no obvious scars at the donor site.