Management of adhesion using a pretarsal fibromuscular flap or graft in secondary blepharoplasty.

BACKGROUND: In double eyelid operations, if the eyes have too little fat and soft tissue, or if too much of the orbital fat was removed during the operation, the double eyelid crease is placed too high and the supratarsal recess becomes hollow and adhesion of the eyelid crease occurs even in the orbital septum and levator muscle. A secondary double eyelid operation in response to these problems needs to correct the height of the eyelid crease by releasing the inadequately high eyelid fold and preventing readhesion. Moreover, in case the muscle and scar tissue are bulged below the incision line, the height of the double eyelid should be appropriately lowered and the bulky lower flap should be flattened. In cases where the adjacent tissue (e.g., preaponeurotic fat) was excessively removed during the primary double eyelid operation, a free fat or dermis fat graft was performed to correct supratarsal depression and readhesion. These graft materials are extracted from a distant donor site.

METHODS: Even if the adjacent tissue was not sufficient, the authors made the superiorly based local flap or graft of pretarsal scar-muscle tissue obtained after thinning the bulky lower flap. In these cases, the fibrous muscle flap or graft compensated tissue depletion with a proper mass around the double eyelid crease, thus helping to prevent readhesion.

RESULTS: Of the 1225 patients with high placement of the supratarsal fold with a bulky lower skin flap, we used pretarsal fibromuscular flaps in 914 patients and pretarsal fibromuscular grafts in treating 311 patients between November of 1997 and October of 2004. In the authors' series, 425 of 1225 patients underwent follow-up ranging from 2 to 23 months. Most of these patients were satisfied; however, 33 patients (7.8 percent) expressed dissatisfaction with the postoperative results based on their subjective judgment; 29 patients (6.8 percent) had mild asymmetry, and surgical revision was required in only 17 patients (4 percent).

CONCLUSIONS: The authors eventually found that the pretarsal fibromuscular flap or graft was successful in making a natural eye shape and preventing readhesion, with no requirement of a distant donor site. They also found that the operation was effective in reducing the operative time and lowering the risk of postoperative infection.