Nasal fat preservation in upper eyelid blepharoplasty

Traditional upper blepharoplasty is a subtractive form of surgery that involves the excision of variable amounts of skin, muscle, and fat from the eyelid. The goal of surgery is to improve field of vision and/or appearance. While surgical debulking of the eyelid may improve appearance early on, the volume loss inherent to this process (especially fat excision) can contribute to a hollowed appearance with an associated deep and sunken superior sulcus. This skeletonized look may be mitigated by repositioning a prominent nasal fat pad, if present, to the central upper eyelid.

The charts of patients who underwent upper blepharoplasty with repositioning of the nasal fat pad (as described in this manuscript) to the central arcus marginalis of the superior orbital rim during surgery were reviewed. Patients with a history of previous eyelid surgery or trauma or who had concurrent ptosis or other eyelid malpositions were excluded from the study. Also excluded were patients who did not manifest prominent nasal fat pads at surgery. Postoperative interval follow up was consistent until 6 months after surgery and more sporadic thereafter, as patients more frequently missed appointments. Postoperative healing issues, patient complaints, complications, and subjective physician and patient satisfaction assessments were noted. Final results were gauged on each patient's final visit after surgery.

Seventy-six patients were included in the study. Forty-eight patients (63%) were women, and 28 patients (37%) were men. The surgical procedure was uneventful in all patients. The average patient age was 66 years and the mean follow up was 11 months (range 6-22 months). There was one case of postoperative pseudo-Brown syndrome, which resolved with steroid injections. There were 2 cases of postoperative presumed mechanical ptosis, early in the series, lasting for 2 weeks, which in both cases responded to oral steroids. Subjectively, there was no new or worsening superior sulcus hollowness observed by patient or surgeon at last follow up in all cases.

Volume loss and the value of fat preservation in lower blepharoplasty are well-documented and accepted among eyelid surgeons. The affect of iatrogenic volume depletion in upper eyelid blepharoplasty, while understood, has gained less attention. Repositioning the prominent nasal fat pad of the upper eyelid to the central sulcus adds little time to surgery, allows preservation of upper eyelid fat during surgery, and may be a useful adjunct to the upper blepharoplasty surgeon. While further studies are needed to more critically assess eyelid volumetric changes, this technique holds promise as a preventative measure for superior sulcus hollowing after surgery.