The eyes have it series, post 118 - a very challenging #EnigmaLift eyelid surgery revision! This one is a bit intricate, and may be most appreciated by my colleagues. This woman had a prior, old school upper and lower eyelid surgery that aggressively removed the fat around her eye and left her very hollowed out and did not address her upper eyelid ptosis (drooping) or her sagging temporal brow.
This old technique is very, very common, even today - unfortunately it causes a significant amount of premature aging in her upper lids, in my opinion, as you see here. It creates what I refer to as an A-frame, or a C-frame deformity of the upper lid, where there is an apex of volume loss and a skeletonized look to the upper lid complex. That look is exacerbated by the sinking ptosis of the upper lid.
I have many strategies to restore A-frame volume loss. Nonsurgically I like to use fat transfer, and occasionally will use filler for this. Surgically, I like to rearrange pre-existing fat pads to cover this deformity, which has great success. Unfortunately here, all of those fat pads that I would normally use have been removed!
More recently, over the past several years, I have been working on utilizing a temporal fascia graft to cover this concave deformity, create a tent, restructure the upper lid, and add volume. It’s a complex process that came to me in the shower (like many things do), and it’s been showing great results with about 4 years under its belt.
For her, I utilized my temporal fascia grafting technique for structure in combination with my stem cell rich #ÔPTIMizedFatTransfer to add natural and soft volume back to the area. I paired those with a very intricate ptosis repair to lift her upper eyelid positions, restore the shape of her eye, and increase her aperture to give her back the eye sizes she had before!
