title: Preaponeurotic fat advancement in levator recession for treatment of upper eyelid retraction.
abstract: BACKGROUND
  Postoperative cosmetic deformities can be encountered after surgical treatments for upper eyelid retraction. The authors described a preaponeurotic fat advancement technique and investigated the effectiveness in patients who underwent levator recession for upper lid retraction.
  
  
  METHODS
  This retrospective comparative case series included 44 patients (57 eyelids) who underwent levator recession surgery with (flap group, n = 31) or without (no-flap group, n = 26) the preaponeurotic fat advancement flap procedure. Comparisons of the marginal reflex distance 1, palpebral fissure, upper palpebral fissure area, pretarsal show, eyelid asymmetry, and cosmetic complications were made between the two groups. Lid position outcomes (good, fair, and poor), which were grouped according to eyelid asymmetry, marginal reflex distance 1, and the position of upper eyelid margin, and cosmetic complications were assessed.
  
  
  RESULTS
  In the flap group, lid position outcomes were graded as good in 16 patients (72.7 percent), fair in four patients (18.2 percent), and poor in two patients (9.1 percent). In the no-flap group, lid position outcomes were good in 15 patients (68.2 percent), fair in five patients (22.7 percent), and poor in two patients (9.1 percent). There were no differences between the two groups in achieving acceptable eyelid lowering and eyelid symmetry (90.9 percent in both groups). However, cosmetic outcomes demonstrated some differences. There were no multiple lid creases in the fat advancement group, compared with six eyes (23.1 percent) without fat advancement.
  
  
  CONCLUSIONS
  Preaponeurotic fat advancement flap is an effective method with which to prevent unintended multiple lid creases and provide satisfactory cosmetic outcomes in levator recession.
authors: Seoul, Republic of Korea; and Baltimore, Md. From the Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine; and the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine.
authors: Ju-Hyang
authors: JH
authors: Lee
authors: Yoon-Duck
authors: YD
authors: Kim
authors: Kyung In
authors: KI
authors: Woo
authors: Owen N
authors: ON
authors: Johnson
mesh_terms: D000273:Adipose Tissue / Q000601:surgery; D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult