BACKGROUND: Upper eyelid blepharoplasty generally is performed as a combination of excess skin reduction and fat resection. Fat resection can in the long term result in a hollow orbit. Therefore, treatment of the lax orbital septum, in combination with skin reduction, seems a more preferable approach than fat resection.The authors describe a technique of upper-eyelid blepharoplasty: a combination of excess skin reduction and shortening of the stretched lax orbital septum by means of bipolar coagulation. This procedure is called bipolar coagulation-assisted orbital septoblepharoplasty, ie, BICO septoblepharoplasty. The aim of this retrospective study is to report on our initial experience with this technique. METHODS: We retrospectively analyzed 296 patients in whom an upper-eyelid blepharoplasty was performed during the past 4 years using the BICO septoblepharoplasty technique: first, excess skin is removed, then a small rim of orbicularis muscle is excised to expose the bulging orbital septum, and finally, before closure of the wound, bipolar coagulation of the exposed orbital septum is performed. This results in shrinkage of the septum and thus in repositioning of the pseudoherniated fat pads. RESULTS: At discharge from follow-up, which varied from 9 weeks (72% of the patients) up till 2 years after surgery (28% of the patients), in all patients ultimately a satisfactory result was achieved and ultimately all were satisfied or very satisfied with the result of the procedure. There were only 3 patients with minor complications: 1 patient with a slightly retracting scar, which resolved spontaneously, and 2 patients with slight asymmetry requiring additional skin resection. CONCLUSIONS: BICO septoblepharoplasty of the upper eyelid seems to be an effective way to treat blepharochalasia of the upper eyelid; the bipolar coagulation of the orbital septum will lead to shrinkage of the septum, thereby repositioning the prolapsing medial and central fat pads. Secondary fibrosis will reinforce the orbital septum postoperatively.

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Annals of Plastic Surgery
Erasmus MC: University Medical Center Rotterdam

van der Lei, B., Timmerman, I. S. K., Cromheecke, M., & Hofer, S. (2007). Bipolar coagulation-assisted orbital (BICO) septoblepharoplasty: A retrospective analysis of a new fat-saving upper-eyelid blepharoplasty technique. Annals of Plastic Surgery, 59(3), 263–267. doi:10.1097/SAP.0b013e31802f63aa