Prevention of Incisional Depression in Double Eyelid Blepharoplasty Using an Elevated Cephalad Orbital Septum Flap Technique

BACKGROUND: Double eyelid blepharoplasty is commonly performed in China. Incisional depression is an established postoperative contour concern, although several contemporary techniques are available to reduce its occurrence. We retrospectively describe outcomes after a full-incision technique using an elevated cephalad orbital septum flap. METHODS: We retrospectively reviewed the records of 898 consecutive patients (821 female and 77 male; mean age: 39.3±12.7 y) who underwent primary double eyelid blepharoplasty by one surgeon at one institution between January 2006 and June 2016. The technique used an elevated cephalad orbital septum flap. Six-month outcomes were summarized descriptively using patient-reported measures, a 4-grade incisional-depression assessment scored from standardized, deidentified photographs, and recorded complications. RESULTS: At 6 months, 845 of 898 patients (94.1%) were very satisfied or satisfied with their appearance. The 4-grade incisional-depression assessment was excellent in 805 patients (89.6%), good in 75 (8.4%), fair in 15 (1.7%), and poor in 3 (0.3%); fair or poor grades occurred in 18 patients (2.0%). Thirty-seven patients (4.1%) had a recorded complication. The most frequent were asymmetry (12/898, 1.3%), partial or complete fold disappearance (10/898, 1.1%), and a wide or narrow fold (6/898, 0.7%). Upper-eyelid contour depression or hollowing (2/898, 0.2%) was recorded separately from incisional scar depression. CONCLUSIONS: In this retrospective, single-surgeon case series, the elevated cephalad orbital septum flap technique was associated with high patient-reported satisfaction and generally favorable 6-month scar assessments. Comparative studies with prospectively defined outcomes are needed to determine whether the technique reduces incisional depression relative to other approaches. LEVELS OF EVIDENCE: Level IV-therapeutic.