Top-down adhesiolysis with orbicularis muscle strap interposition in revisional blepharoplasty: a dual refinement for functional and aesthetic restoration

Scar formation from prior blepharoplasty often disturbs the layered anatomy of the upper eyelid, complicating identification of the levator aponeurosis. This challenge is especially pronounced in revision cases where prior dissection or resection was excessive, producing complications such as unintended triple eyelid folds or injury to the levator aponeurosis. We propose a dual refinement technique: a top-down approach to adhesiolysis, which enhances levator identification under scarred conditions and use of an orbicularis muscle strap instead of muscle resection, thereby preserving tissue volume and buffering postoperative adhesion. Additionally, splitting the orbicularis muscle 3 mm inferior to the upper skin incision line maintains subincisional soft tissue, reducing the likelihood of unwanted adhesions and fold formation. This technique was applied in a complex revision case, achieving both functional correction and stable aesthetic results while minimizing complications.