The extended submuscular fibroadipose tissue (SMFAT) resection and ladder suture technique for patients with a puffy SMFAT upper eyelid

In East Asians, a common method to ameliorate puffy eyelids is to resect the excess orbital fat and the orbicularis. However, in some patients, a satisfactory improvement cannot be achieved because of the thick submuscular fibroadipose tissue (SMFAT) and minimal orbital fat. The SMFAT lies between the orbicularis and the orbital septum and can also be found in the pretarsal area. It is responsible for puffy eyelids and the slackening of the tissue after removal. In this study, we combined an extended SMFAT resection with the ladder suture technique to correct puffy SMFAT eyelids.A total of 76 patients with a thick SMFAT and minimal orbital fat were recruited. The thick SMFAT, which included the soft tissue near the artificial fold and the pretarsal area soft tissue, was resected. The ladder suture technique was performed by positioning the stitch 1 mm below the orbicularis margin after a skin flap margin puncture. The esthetic effect was evaluated pre-operatively and at 12 months post-operatively.The pre-operative thickness of the SMFAT and full layers of the eyelid were 0.27 ± 0.03 mm and 2.01 ± 0.11 mm, respectively. One year after surgery, the thickness was 0.08 ± 0.02 mm and 1.68 ± 0.14 mm, respectively (p < 0.05). The post-operative upper eyelash lift-up angle and the eyelash exposure length were significantly increased on both sides compared with the pre-surgery (p < 0.05). No patients experienced complications.An extended SMFAT resection combined with the ladder suture technique can effectively correct puffy SMFAT eyelids without complications.