title: Preaponeurotic fat advancement for prevention of unexpected higher eyelid crease in upper eyelid-lengthening surgery.
abstract: OBJECTIVE
  To present a modified technique based on preaponeurotic fat advancement for preventing higher eyelid crease in upper eyelid-lengthening surgery.
  
  
  METHODS
  Outcomes of Japanese patients with Graves' orbitopathy-related upper eyelid retraction who underwent transcutaneous upper eyelid-lengthening surgery were reviewed. The minimum follow-up period was 6 months. A total of 17 upper eyelids in 11 patients (average age, 38.4 years) were included. After confirming appropriate upper eyelid lowering with good contour, preaponeurotic fat was fully exposed and fixed on the upper tarsal plate 1 mm superior to the planned eyelid crease with 5 sutures. Skin-tarsus-skin sutures were placed to create an eyelid crease and close the skin. Simple suture tarsorrhaphy was performed with 2 sutures.
  
  
  RESULTS
  No upper eyelids demonstrated higher eyelid crease postsurgically. Upper eyelid fullness caused by the advanced preaponeurotic fat was not conspicuous.
  
  
  CONCLUSIONS
  Our technique is a countermeasure against higher eyelid crease in upper eyelid-lengthening surgery.
authors.affiliation: Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan. cosme@d1.dion.ne.jp
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kakizaki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ichinose
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Iwaki
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome