Fran Lowry

October 05, 2010

October 6, 2010 (Toronto, Canada) — Safe rejuvenation of the upper eyelid with autologous fat injections is possible with a novel technique that takes into account the critical anatomy of the eyes, researchers announced here at Plastic Surgery 2010: Joint Annual Scientific Meeting of the American Society of Plastic Surgery and the Canadian Society of Aesthetic Plastic Surgery.

Researchers used cadavers to practice the new technique until they felt confident that they could do it safely in humans.

"We were noting that, even though we could give someone a beautiful rejuvenation in their upper face, their lower face, and their neck, we missed out on the people who had a sunken-in eye appearance, or that deep sulcus in the upper lids," explained Patrick K. Sullivan, MD, a plastic surgeon from Brown University School of Medicine in Providence, Rhode Island, who developed the technique. "It doesn't happen to everybody, but it happens to enough people, so we thought this is something that we have to address. Our goal is to give each patient a very natural appearance."

Fat grafting has been used to correct enophthalmos (or recessed eyeball), but injecting fat into the eyelid is associated with a higher risk for fat embolus. To refine this approach and make it safer, the researchers injected fat that was labeled with methylene blue — so it could be better seen following injection — into the upper eyelids of cadavers using a 17-gauge fat grafting cannula.

They then dissected the cadavers to determine the exact anatomical location of the labeled fat. "We wanted to make sure that it was in the right plane because we didn't want to do anything that could potentially cause a problem with the eye," Dr. Sullivan explained.

When they were satisfied that the fat was in a safe position, in the retro-orbicularis oculi fat pad, with no postseptal extension, the doctors performed the procedure in 40 upper eyelids in 21 consecutive female patients. Their mean age was 56.6 years, and 0.2 to 2.3 cc were injected in each eyelid.

In some cases, there was undergrafting of fat; this was treated with repeat fat grafting or soft-tissue fillers, Dr. Sullivan said.

Follow-up out to 16 months shows that the results are durable, he added.

"We don't plan to ever have to do any more fat grafting because these fat cells are alive; they have good supply where we are putting them, which keeps them alive. So at 9, 12, 16 months, the fat stays there. It may soften a little bit, and may change a little bit in that it seems to bring about a more natural appearance with time. In the beginning, there seems to be a little bit of swelling, but that swelling goes away," Dr. Sullivan said.

Commenting on this new technique, Joseph P. Hunstad, from the University of North Carolina in Chapel Hill and president of the Hunstad Center for Cosmetic Plastic Surgery, who moderated the session, said that fat augmentation of the upper lid sulcus "can correct hollowing and each deformity of the depleted upper eyelid. The description of the procedure was very straightforward and [the researchers] showed excellent results with minimal morbidity."

Dr. Hunstad told Medscape Medical News that the concept has excellent clinical application. "I can see using it myself in the near future."

Dr. Sullivan and Dr. Hunstad have disclosed no relevant financial relationships.

Plastic Surgery 2010: Joint Annual Scientific Meeting of the American Society of Plastic Surgery (ASPS) and the Canadian Society of Aesthetic Plastic Surgery (CSAPS). Presented October 3, 2010.