Upper-Eyelid Fat Repositioning Needed in Double-Eyelid Surgery for Sunken Eyes

Among people planning double-eyelid surgery, it is common for the upper eyelids to look sunken or for a double fold to occur.

If there is too much fat in the eyelids, the upper eyelids may look puffy; if there is too little fat, they may look sunken. Therefore, having an appropriate amount of fat is desirable.

Comparison of eyelid fat in a sufficient upper eyelid and a sunken eye

When there is enough fat in the upper eyelid, a proper lubricating layer created by the fat pocket exists between the skin and the levator aponeurosis, so adhesion does not occur between the skin and the levator aponeurosis.

However, if the upper eyelid lacks fat, there is no lubricating layer between the levator aponeurosis and the eyelid skin, so adhesion can occur. This may lead to a double fold in the eyelid, and in severe cases, deep sunken eyes called an “eye hole” can occur.

"Double-eyelid surgery to improve sunken eyes"

To improve sunken eyes, a simple eyelid fat grafting procedure may be possible. However, if the height of the double eyelids is different, performing upper-eyelid fat repositioning together with incisional double-eyelid surgery leads to higher cosmetic satisfaction.

Cases requiring correction because the height of the double eyelids differs

The important point in double-eyelid surgery for sunken eyes is to create the double eyelid in the proper position and to determine the amount of skin to be excised from the eyelid appropriately.

And the eyelid fat pocket must be located properly, and the space between the fat pocket and the levator aponeurosis must be carefully dissected.

In addition, the fibrous tissue surrounding the orbital fat must be delicately dissected so that the orbital fat can descend well downward.

The levator aponeurosis and orbital fat

If it is determined during the dissection process that eye-opening correction is needed, eye-opening correction should be performed and the double eyelid should be created properly in the appropriate position so that a double fold does not occur.

The surgical process of upper-eyelid fat repositioning

Finally, before suturing the skin, the well-dissected upper eyelid fat is moved downward and fixed. This is called “upper-eyelid fat repositioning.”

By creating an appropriate fat lubricating layer between the levator aponeurosis and the skin through upper-eyelid fat repositioning, sunken eyes can be improved aesthetically, and functionally it can help prevent ptosis and reduce eye fatigue.

Double-eyelid surgery for sunken eyes. Review of upper-eyelid fat repositioning

Additional upper-eyelid fat grafting may also be needed, but if the primary sunken appearance is addressed through upper-eyelid fat repositioning, good results can be achieved with only a small amount of fat grafting to the upper eyelid.

If too much fat is grafted into the upper eyelid, the eyelid may become heavy, and the transplanted fat may be palpable through the thin eyelid skin, so caution is needed.

Upper-eyelid fat repositioning in double-eyelid surgery for sunken eyes