{"title":"A Novel Preoperative Design Utilizing the Rouleau Phenomenon for Sunken Eyelids.","authors":"Jin Hwang, Tae Hwan Park","doi":"10.1007/s00266-025-05006-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Correcting sunken eyelids is challenging. This is because the eyelid skin easily moves according to orbital fat volume, making it difficult to predict, which can lead to asymmetrical or unfavorable results. Currently, the preoperative design method for understanding the Rouleau phenomenon and using it to push the lower bag can be helpful as it reduces asymmetry and offers greater predictability. The current study shares our experiences of sunken eyelid correction either by combined upper blepharoplasty and micro-fat grafting. We also introduce our unique preoperative design utilizing the Rouleau phenomenon.</p><p><strong>Methods: </strong>This study included 60 patients who underwent upper blepharoplasty with a fat graft to correct sunken eyelids. It is a retrospective review of 60 cases from August 2021 to April 2023.</p><p><strong>Results: </strong>This study included sixty patients who underwent fat grafting (FG) for sunken eyelid correction and/or upper blepharoplasty (UB) between August 2021 and April 2023. There were nine cases (15%) in which only FG was performed without the need for UB, and 43 cases (71.7%) involved patients who underwent both UB and FG together and achieved aesthetic satisfaction after only one surgery. Revisional surgery was performed when the results were unsatisfactory after the first surgery, which included persistently visible wrinkles, sunken undercorrection, and palpable lumps.</p><p><strong>Conclusions: </strong>We successfully corrected sunken eyelids in the Asian population with a customized approach using fat grafting and/or upper blepharoplasty based on our unique preoperative design utilizing the Rouleau phenomenon. This will assist plastic surgeons in achieving a better aesthetic outcome in this challenging area.</p><p><strong>Level of evidence iv: </strong>This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.</p>","PeriodicalId":7609,"journal":{"name":"Aesthetic Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Aesthetic Plastic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00266-025-05006-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Correcting sunken eyelids is challenging. This is because the eyelid skin easily moves according to orbital fat volume, making it difficult to predict, which can lead to asymmetrical or unfavorable results. Currently, the preoperative design method for understanding the Rouleau phenomenon and using it to push the lower bag can be helpful as it reduces asymmetry and offers greater predictability. The current study shares our experiences of sunken eyelid correction either by combined upper blepharoplasty and micro-fat grafting. We also introduce our unique preoperative design utilizing the Rouleau phenomenon.
Methods: This study included 60 patients who underwent upper blepharoplasty with a fat graft to correct sunken eyelids. It is a retrospective review of 60 cases from August 2021 to April 2023.
Results: This study included sixty patients who underwent fat grafting (FG) for sunken eyelid correction and/or upper blepharoplasty (UB) between August 2021 and April 2023. There were nine cases (15%) in which only FG was performed without the need for UB, and 43 cases (71.7%) involved patients who underwent both UB and FG together and achieved aesthetic satisfaction after only one surgery. Revisional surgery was performed when the results were unsatisfactory after the first surgery, which included persistently visible wrinkles, sunken undercorrection, and palpable lumps.
Conclusions: We successfully corrected sunken eyelids in the Asian population with a customized approach using fat grafting and/or upper blepharoplasty based on our unique preoperative design utilizing the Rouleau phenomenon. This will assist plastic surgeons in achieving a better aesthetic outcome in this challenging area.
Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
期刊介绍:
Aesthetic Plastic Surgery is a publication of the International Society of Aesthetic Plastic Surgery and the official journal of the European Association of Societies of Aesthetic Plastic Surgery (EASAPS), Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica (SICPRE), Vereinigung der Deutschen Aesthetisch Plastischen Chirurgen (VDAPC), the Romanian Aesthetic Surgery Society (RASS), Asociación Española de Cirugía Estética Plástica (AECEP), La Sociedad Argentina de Cirugía Plástica, Estética y Reparadora (SACPER), the Rhinoplasty Society of Europe (RSE), the Iranian Society of Plastic and Aesthetic Surgeons (ISPAS), the Singapore Association of Plastic Surgeons (SAPS), the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), the Egyptian Society of Plastic and Reconstructive Surgeons (ESPRS), and the Sociedad Chilena de Cirugía Plástica, Reconstructiva y Estética (SCCP).
Aesthetic Plastic Surgery provides a forum for original articles advancing the art of aesthetic plastic surgery. Many describe surgical craftsmanship; others deal with complications in surgical procedures and methods by which to treat or avoid them. Coverage includes "second thoughts" on established techniques, which might be abandoned, modified, or improved. Also included are case histories; improvements in surgical instruments, pharmaceuticals, and operating room equipment; and discussions of problems such as the role of psychosocial factors in the doctor-patient and the patient-public interrelationships.
Aesthetic Plastic Surgery is covered in Current Contents/Clinical Medicine, SciSearch, Research Alert, Index Medicus-Medline, and Excerpta Medica/Embase.