Correction of sunken upper eyelid with orbital fat transposition flap and dermofat graft

Sunken upper eyelid is a commonly found deformity among Asians, mostly due to the aging process and excessive orbital fat removal during oriental blepharoplasty procedures. This deformity is frequently accompanied by multiple, poorly defined upper eyelid folds and blepharoptosis. To date, autologous fat graft has been the treatment of choice for this group of patients. However, accurate placement of the graft in the orbital fat is quite challenging, and it can result in contour irregularities when injected into the preseptal plane.

From 2008 to 2013, 60 patients with sunken upper eyelids were treated with either an orbital fat transposition flap or a dermofat graft according to the severity of the deformity. Mild sunken upper eyelids were corrected during upper blepharoplasty by exposing the central orbital fat sac and transposing it in a flap-like manner. In more severe cases, a dermofat graft harvested from the intergluteal crease was used.

Postoperative complications included difficulty in eye opening because of the weight of the dermofat graft and swelling of the periorbit, which gradually resolved with time. Mild bruising, tenderness, asymmetry, and blepharoptosis were also noted, but no additional treatments were necessary. During the 13-month follow-up period, two patients from the orbital fat transposition flap group and one patient from the dermofat graft group underwent revision surgeries.

Anatomy of the orbit, prior surgical history, and sunkenness of the upper eyelid were all considered during preoperative planning. Either an orbital fat transposition flap or a dermofat graft was applied, according to the severity of the deformity, with successful results. Particularly in mild cases of sunken upper eyelid deformity, an orbital fat transposition flap is an easy and effective method that requires no additional procedures.