A new technique for correction of iatrogenic upper eyelid retraction by using a composite flap of the orbicularis muscle and fascia on the anterior surface of the tarsal plate

Background: Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty. To avoid extra trauma, we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC) on the anterior surface of the tarsal plate. This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS), which can achieve a good correction for post-blepharoplasty retraction.Methods: We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019. The OFC was used to replace the missing part of the LPS, and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted. Postoperative outcome measurements included postoperative binocular symmetry, double eyelid smoothness, eyelid fullness,margin reflex distance(MRD1), degree of eyelid closure, and exposure keratitis. The patients were followed-up at seven days, one month, and six months postoperatively.Results: One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively, with the upper eyelid margin located at the upper edge of the pupil. The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin. Other observational indicators were satisfactory,including binocular symmetry, double eyelid fluency, and eyelid fullness. During the follow-up, no exposure keratitis was identified. The MRD1 indexes after the operation were significantly different(P<0.001) from those before the procedure.Conclusions: Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.