(Revision surgery by Dr. Frank Meronk)
This young patient had incisional double eyelid surgery performed elsewhere nearly three years earlier. When seen in our office, each upper lid demonstrated:
• multiple skin folds rising high up the lid
• no main crease
• loss of normal youthful volume (hollowness)
• mild ptosis (lid droopiness)
Without adequate volume extending forward from the deeper socket, the eyelid skin crumples into multiple uneven folds, much like a deflated balloon.
Some surgeons recommend excising more skin to create one dominant fold, an inappropriate maneuver that may leave the lid too tight and short of outer covering to close fully and may all but preclude the possibility of future reinflation.
Upon surgical exploration, the area beneath the skin and closing muscle was found to be essentially devoid of remaining fat.
Missing volume was replaced by moving a large but smooth flap of orbital fat out of the socket and across the barren expanse of lid (internal orbital fat relocation).
The deeper orbital fat was then replenished by grafting pearl-sized pieces of fat obtained from the lower abdomen into the anterior socket (orbital fat grafting).
A crease was created using deep fixation over the newly-inflated lid. The mild ptosis present preoperatively self-corrected with volume restoration.
