Research progress of iatrogenic blepharoptosis repair after double eyelid surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Xiangjun ,  FANG Bairong

Department of Plastic Surgery, Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P. R. China;

Corresponding author：

FANG Bairong, Email: fbrfbr2004@csu.edu.cn

Keywords：

Repair after double eyelid surgery; iatrogenic blepharoptosis; complication

DOI：

10.7507/1002-1892.202302060

Video：

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Objective To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia. Methods To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications. Results Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion. Conclusion When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.

Citation： LIU Xiangjun, FANG Bairong. Research progress of iatrogenic blepharoptosis repair after double eyelid surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 732-735. doi: 10.7507/1002-1892.202302060 Copy

1.	Kim DW, Bhatki AM. Upper blepharoplasty in the Asian eyelid. Facial Plast Surg Clin North Am, 2007, 15(3): 327-335.
2.	Doxanas MT, Anderson RL. Oriental eyelids. An anatomic study. Arch Ophthalmol, 1984, 102(8): 1232-1235.
3.	《上睑下垂诊治专家共识》制定专家组. 上睑下垂诊治专家共识. 中华医学杂志, 2017, 97(6): 406-411.
4.	Wang X, Du Y, Wu H, et al. Repair techniques for failed double-eyelids involving restoration of eyelid anatomical structure and function. Aesthetic Plast Surg, 2019, 43(3): 702-710.
5.	Zhang Y, Yuan L, Sun B, et al. Repair of unsatisfactory double eyelid after double-eyelid blepharoplasty in Asian patients. Arch Facial Plast Surg, 2010, 12(4): 236-240.
6.	Ahuero AE, Hatton MP. Eyelid malposition after cataract and refractive surgery. Int Ophthalmol Clin, 2010, 50(1): 25-36.
7.	Bacharach J, Lee WW, Harrison AR, et al. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye (Lond), 2021, 35(9): 2468-2481.
8.	Kim KK, Kim WS, Oh SK, et al. High double eyelid fold correction using wide dual-plane dissection. Ann Plast Surg, 2017, 78(4): 365-370.
9.	Wattanakrai K, Chiemchaisri N, Wattanakrai P. Secondary blepharoplasty: Correction of the high fold. Aesthetic Plast Surg, 2016, 40(6): 914-920.
10.	Guo S, Yang M, Zhou C, et al. Corrective strategies for a complex deformity caused by “European-style double eyelid” blepharoplasty in Asians. Aesthetic Plast Surg, 2019, 43(2): 395-403.
11.	Young SM, Kim YD, Kim JH, et al. Lowering of the high eyelid crease in revision upper eyelid surgery. Aesthetic Plast Surg, 2019, 43(1): 139-146.
12.	朱惠敏, 屠晓勤, 徐乃江. 腱膜性上睑下垂及手术治疗. 中国实用眼科杂志, 1999, 17(2): 117-118.
13.	Yang P, Ko AC, Kikkawa DO, et al. Upper eyelid blepharoplasty: Evaluation, treatment, and complication minimization. Semin Plast Surg, 2017, 31(1): 51-57.
14.	Walsh FB. Clinical Neuro-ophthalmology. 2nd ed. Baltimore, MD: Williams & Wilkins, 1957: 196.
15.	Cetinkaya A, Kersten RC. Surgical outcomes in patients with bilateral ptosis and Hering’s dependence. Ophthal-mology, 2012, 119(2): 376-381.
16.	Bernardini FP, Cetinkaya A, Zambelli A. Treatment of unilateral congenital ptosis: putting the debate to rest. Curr Opin Ophthalmol, 2013, 24(5): 484-487.
17.	Small RG. The surgical treatment of unilateral severe congenital blepharoptosis: the controversy continues. Ophthalmic Plast Reconstr Surg, 2000, 16(2): 81-82.
18.	刘欢, 方柏荣. 上睑提肌前徙在矫正重睑术后宽重睑伴上睑下垂中的应用. 中华整形外科杂志, 2022, 38(9): 993-997.
19.	Chen WP. The concept of a glide zone as it relates to upper lid crease, lid fold, and application in upper blepharoplasty. Plast Reconstr Surg, 2007, 119(1): 379-386.
20.	Billon N, Dani C. Developmental origins of the adipocyte lineage: new insights from genetics and genomics studies. Stem Cell Rev Rep, 2012, 8(1): 55-66.
21.	Liu HP, Shao Y, Li B, et al. Upper blepharoplasty revision technique: Correction of the high eyelid fold using the pretarsal orbicularis oculi flap. J Plast Reconstr Aesthet Surg, 2019, 72(1): 125-130.
22.	李欣欣, 刘育凤, 刘宁, 等. 眼轮匝肌后脂肪眶隔瓣修复不良重睑术组织缺损的效果. 中华医学美学美容杂志, 2020, 26(4): 302-305.
23.	Tsai CC, Lin TM, Chou CS, et al. Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous levator muscle resection. Ann Plast Surg, 2003, 50(3): 292-295.
24.	王佳琦, 王祎蓉, 郭鑫, 等. 重睑成形术后睑粘连畸形的修复. 中华医学美学美容杂志, 2009, 15(1): 1-3.
25.	Lee W, Kwon SB, Oh SK, et al. Correction of sunken upper eyelid with orbital fat transposition flap and dermofat graft. J Plast Reconstr Aesthet Surg, 2017, 70(12): 1768-1775.
26.	苏治国. 下睑袋脂肪游离移植填充上睑凹陷. 北京: 北京协和医学院, 2018.
27.	Krastev TK, Schop SJ, Hommes J, et al. Autologous fat transfer to treat fibrosis and scar-related conditions: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg, 2020, 73(11): 2033-2048.
28.	Klinger M, Caviggioli F, Klinger FM, et al. Autologous fat graft in scar treatment. J Craniofac Surg, 2013, 24(5): 1610-1615.
29.	Negenborn VL, Groen JW, Smit JM, et al. The use of autologous fat grafting for treatment of scar tissue and scar-related conditions: A systematic review. Plast Surg Nurs, 2016, 36(3): 131-143.
30.	Zhou X, Zeng N, Wang H. Correction of upper-eyelid depression through retro-orbicularis oculi fat (ROOF) augmentation using periumbilical adipose graft. Aesthetic Plast Surg, 2020, 44(6): 2131-2136.
31.	Lin TM, Lin TY, Chou CK, et al. Application of microautologous fat transplantation in the correction of sunken upper eyelid. Plast Reconstr Surg Glob Open, 2014, 2(11): e259. doi: 10.1097/GOX.0000000000000141.
32.	Mizuno T. Treatment of suture-related complications of buried-suture double-eyelid blepharoplasty in Asians. Plast Reconstr Surg Glob Open, 2016, 4(8): e839. doi: 10.1097/GOX.00000000-00000835.
33.	Patel RM, Aakalu VK, Setabutr P, et al. Efficacy of Muller’s muscle and conjunctiva resection with or without tarsectomy for the treatment of severe involutional blepharoptosis. Ophthalmic Plast Reconstr Surg, 2017, 33(4): 273-278.
34.	Saonanon P, Sithanon S. External levator advancement versus Müller muscle-conjunctival resection for aponeurotic blepharoptosis: A randomized clinical trial. Plast Reconstr Surg, 2018, 141(2): 213e-219e.
35.	Liu CY, Chhadva P, Setabutr P. Blepharoptosis repair. Curr Opin Otolaryngol Head Neck Surg, 2018, 26(4): 221-226.
36.	Ozturk Karabulut G, Fazil K, Karaagac Gunaydin Z, et al. Müller muscle conjunctiva resection for revision of residual ptosis after external levator advancement surgery. Ophthalmic Plast Reconstr Surg, 2020, 36(5): 458-462.
37.	Liu MT, Totonchi A, Katira K, et al. Outcomes of mild to moderate upper eyelid ptosis correction using Müller’s muscle-conjunctival resection. Plast Reconstr Surg, 2012, 130(6): 799e-809e.
38.	Sajja K, Putterman AM. Müller’s muscle conjunctival resection ptosis repair in the aesthetic patient. Saudi J Ophthalmol, 2011, 25(1): 51-60.
39.	Wang H, Liu L, Wang ZJ. Conjoint fascial sheath suspension for early correction of severe blepharoptosis after double-eyelid blepharoplasty. Br J Oral Maxillofac Surg, 2020, 58(8): 966-969.
40.	Hao DY, Cang ZQ, Cui JB, et al. Conjoint fascial sheath suspension for correction of recurrent blepharoptosis. Aesthetic Plast Surg, 2022, 46(2): 744-751.

1. Kim DW, Bhatki AM. Upper blepharoplasty in the Asian eyelid. Facial Plast Surg Clin North Am, 2007, 15(3): 327-335.
2. Doxanas MT, Anderson RL. Oriental eyelids. An anatomic study. Arch Ophthalmol, 1984, 102(8): 1232-1235.
3. 《上睑下垂诊治专家共识》制定专家组. 上睑下垂诊治专家共识. 中华医学杂志, 2017, 97(6): 406-411.
4. Wang X, Du Y, Wu H, et al. Repair techniques for failed double-eyelids involving restoration of eyelid anatomical structure and function. Aesthetic Plast Surg, 2019, 43(3): 702-710.
5. Zhang Y, Yuan L, Sun B, et al. Repair of unsatisfactory double eyelid after double-eyelid blepharoplasty in Asian patients. Arch Facial Plast Surg, 2010, 12(4): 236-240.
6. Ahuero AE, Hatton MP. Eyelid malposition after cataract and refractive surgery. Int Ophthalmol Clin, 2010, 50(1): 25-36.
7. Bacharach J, Lee WW, Harrison AR, et al. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye (Lond), 2021, 35(9): 2468-2481.
8. Kim KK, Kim WS, Oh SK, et al. High double eyelid fold correction using wide dual-plane dissection. Ann Plast Surg, 2017, 78(4): 365-370.
9. Wattanakrai K, Chiemchaisri N, Wattanakrai P. Secondary blepharoplasty: Correction of the high fold. Aesthetic Plast Surg, 2016, 40(6): 914-920.
10. Guo S, Yang M, Zhou C, et al. Corrective strategies for a complex deformity caused by “European-style double eyelid” blepharoplasty in Asians. Aesthetic Plast Surg, 2019, 43(2): 395-403.
11. Young SM, Kim YD, Kim JH, et al. Lowering of the high eyelid crease in revision upper eyelid surgery. Aesthetic Plast Surg, 2019, 43(1): 139-146.
12. 朱惠敏, 屠晓勤, 徐乃江. 腱膜性上睑下垂及手术治疗. 中国实用眼科杂志, 1999, 17(2): 117-118.
13. Yang P, Ko AC, Kikkawa DO, et al. Upper eyelid blepharoplasty: Evaluation, treatment, and complication minimization. Semin Plast Surg, 2017, 31(1): 51-57.
14. Walsh FB. Clinical Neuro-ophthalmology. 2nd ed. Baltimore, MD: Williams & Wilkins, 1957: 196.
15. Cetinkaya A, Kersten RC. Surgical outcomes in patients with bilateral ptosis and Hering’s dependence. Ophthal-mology, 2012, 119(2): 376-381.
16. Bernardini FP, Cetinkaya A, Zambelli A. Treatment of unilateral congenital ptosis: putting the debate to rest. Curr Opin Ophthalmol, 2013, 24(5): 484-487.
17. Small RG. The surgical treatment of unilateral severe congenital blepharoptosis: the controversy continues. Ophthalmic Plast Reconstr Surg, 2000, 16(2): 81-82.
18. 刘欢, 方柏荣. 上睑提肌前徙在矫正重睑术后宽重睑伴上睑下垂中的应用. 中华整形外科杂志, 2022, 38(9): 993-997.
19. Chen WP. The concept of a glide zone as it relates to upper lid crease, lid fold, and application in upper blepharoplasty. Plast Reconstr Surg, 2007, 119(1): 379-386.
20. Billon N, Dani C. Developmental origins of the adipocyte lineage: new insights from genetics and genomics studies. Stem Cell Rev Rep, 2012, 8(1): 55-66.
21. Liu HP, Shao Y, Li B, et al. Upper blepharoplasty revision technique: Correction of the high eyelid fold using the pretarsal orbicularis oculi flap. J Plast Reconstr Aesthet Surg, 2019, 72(1): 125-130.
22. 李欣欣, 刘育凤, 刘宁, 等. 眼轮匝肌后脂肪眶隔瓣修复不良重睑术组织缺损的效果. 中华医学美学美容杂志, 2020, 26(4): 302-305.
23. Tsai CC, Lin TM, Chou CS, et al. Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous levator muscle resection. Ann Plast Surg, 2003, 50(3): 292-295.
24. 王佳琦, 王祎蓉, 郭鑫, 等. 重睑成形术后睑粘连畸形的修复. 中华医学美学美容杂志, 2009, 15(1): 1-3.
25. Lee W, Kwon SB, Oh SK, et al. Correction of sunken upper eyelid with orbital fat transposition flap and dermofat graft. J Plast Reconstr Aesthet Surg, 2017, 70(12): 1768-1775.
26. 苏治国. 下睑袋脂肪游离移植填充上睑凹陷. 北京: 北京协和医学院, 2018.
27. Krastev TK, Schop SJ, Hommes J, et al. Autologous fat transfer to treat fibrosis and scar-related conditions: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg, 2020, 73(11): 2033-2048.
28. Klinger M, Caviggioli F, Klinger FM, et al. Autologous fat graft in scar treatment. J Craniofac Surg, 2013, 24(5): 1610-1615.
29. Negenborn VL, Groen JW, Smit JM, et al. The use of autologous fat grafting for treatment of scar tissue and scar-related conditions: A systematic review. Plast Surg Nurs, 2016, 36(3): 131-143.
30. Zhou X, Zeng N, Wang H. Correction of upper-eyelid depression through retro-orbicularis oculi fat (ROOF) augmentation using periumbilical adipose graft. Aesthetic Plast Surg, 2020, 44(6): 2131-2136.
31. Lin TM, Lin TY, Chou CK, et al. Application of microautologous fat transplantation in the correction of sunken upper eyelid. Plast Reconstr Surg Glob Open, 2014, 2(11): e259. doi: 10.1097/GOX.0000000000000141.
32. Mizuno T. Treatment of suture-related complications of buried-suture double-eyelid blepharoplasty in Asians. Plast Reconstr Surg Glob Open, 2016, 4(8): e839. doi: 10.1097/GOX.00000000-00000835.
33. Patel RM, Aakalu VK, Setabutr P, et al. Efficacy of Muller’s muscle and conjunctiva resection with or without tarsectomy for the treatment of severe involutional blepharoptosis. Ophthalmic Plast Reconstr Surg, 2017, 33(4): 273-278.
34. Saonanon P, Sithanon S. External levator advancement versus Müller muscle-conjunctival resection for aponeurotic blepharoptosis: A randomized clinical trial. Plast Reconstr Surg, 2018, 141(2): 213e-219e.
35. Liu CY, Chhadva P, Setabutr P. Blepharoptosis repair. Curr Opin Otolaryngol Head Neck Surg, 2018, 26(4): 221-226.
36. Ozturk Karabulut G, Fazil K, Karaagac Gunaydin Z, et al. Müller muscle conjunctiva resection for revision of residual ptosis after external levator advancement surgery. Ophthalmic Plast Reconstr Surg, 2020, 36(5): 458-462.
37. Liu MT, Totonchi A, Katira K, et al. Outcomes of mild to moderate upper eyelid ptosis correction using Müller’s muscle-conjunctival resection. Plast Reconstr Surg, 2012, 130(6): 799e-809e.
38. Sajja K, Putterman AM. Müller’s muscle conjunctival resection ptosis repair in the aesthetic patient. Saudi J Ophthalmol, 2011, 25(1): 51-60.
39. Wang H, Liu L, Wang ZJ. Conjoint fascial sheath suspension for early correction of severe blepharoptosis after double-eyelid blepharoplasty. Br J Oral Maxillofac Surg, 2020, 58(8): 966-969.
40. Hao DY, Cang ZQ, Cui JB, et al. Conjoint fascial sheath suspension for correction of recurrent blepharoptosis. Aesthetic Plast Surg, 2022, 46(2): 744-751.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of iatrogenic blepharoptosis repair after double eyelid surgery

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