In senile patients with sunken superior sulcus, involutional ptosis, and higher eyelid crease, a single operation to correct depression or ptosis cannot achieve good results. We demonstrated the anatomy of periorbital septum fibers, which may contribute to the levator muscle's volume depletion and dynamic power transmission disorder, and described a procedure for correcting upper-eyelid depression and blepharoptosis in senile patients. The fibrous webs in these patients connected the posterior aspect of the orbicularis and the orbital septum and extended to the orbital fat and levator aponeurosis. These fibers were dissected to release the periorbital septal fibers, and the orbital septal fat flap was transferred to the depressed region. Advancement or plication of the levator aponeurosis was performed in patients with uncorrected blepharoptosis after the procedures described above. The technique was applied to 13 Chinese patients (25 eyes) between May 2021 and April 2022. Postoperative magnetic resonance imaging revealed that the preaponeurotic fat was displaced forward and down to the upper margin of the tarsus, and the curvature of the upper-eyelid depression was significantly improved. Moreover, the superior sulcus deformity improved, the ptosis was corrected, and the uppermost crease decreased in all patients. No recurrence of ptosis or abnormal adhesion was observed. We believe this is the first study using magnetic resonance imaging to evaluate eyelid anatomy and the effects of surgery in this patient group. Releasing periorbital septum fibers is crucial for correcting a portion of the sunken eyelid and ptosis in Asians.

Background Due to the small and weak septal cartilage of Asians, it’s a challenge to obtain ideal tip projection and nose lengthening by septal extension graft using only septal cartilage. Objectives This study was aim to introduce a septal extension graft complex using nasal septal cartilage and the perpendicular plate of ethmoid (PPE) bone as well as bilateral auricular cartilage, and examine its effectiveness in terms of morphological and mechanical support. Methods Septal cartilage was harvested under an endoscope according to standard techniques. Two pieces of PPE were placed on either side of the “L” strut, served as two spreader grafts. A double-layer of auricular cartilage was fixed as columellar strut grafts. Three-dimensional facial scanning was used to examine the change of three parameters. Nasal tip resistance was evaluated by a digital Newton meter. Results A total of 25 patients were followed up over a mean postoperative duration of 25.9 months. The analysis showed significant differences in both contour parameters and nasal resistance; nasal length (41.4±4.0 vs 46.2±3.4 mm, p<0.05) and nasal tip projection (21.3±3.2 vs 24.4±2.7 mm, p<0.05) appeared to increase postoperatively, while nasolabial angle (117.6±5.9° vs 109.5±5.3°, p<0.05) showed a significant decrease after surgery. The resistance of the nasal tip also increased significantly (p < 0.05) at the displacement of 1mm, 2mm, and 3mm. All patients were satisfied with the aesthetic results, and no serious complications occur. Conclusions This kind of modified SEG technique can effectively adjust nasal morphology for short-nose East Asians.