Various procedures to efface age-related lower eyelid/cheek interface depressions, or primary periorbital hollows (POHs), have been reported in the literature. Postsurgical, or secondary, POHs are a distinct contour irregularity that have received little such attention. Dermal onlay grafts (DOGs), a site-specific term for autologous dermis fat grafts, have been used to treat secondary POHs for which less invasive measures have proved unsuccessful.
The aim of this study was to describe the surgical technique and outcomes of DOGs for secondary POHs.
A retrospective analysis of patients who underwent DOGs for secondary POHs over a 27-month period was performed. The surgical technique and outcomes are reviewed.
Thirteen patients (10 women and 3 men; average age, 52 years; average follow-up, 9 months) were included in the study. Nine patients had bilateral surgery, and all had received previous filler or fat injection, or both, with poor outcomes. Generally, surgical complications were minor, required minimal intervention, or were self-limiting. One patient had persistent infraorbital dysesthesia which improved with oral tricyclic antidepressant treatment. Eleven of 13 patients stated satisfaction with hollow effacement and outcome, a finding verified by subjective assessment by a surgeon.
DOGs yielded good results in this initial description of their utility as a rescue procedure to surgically address secondary POHs. Further quantitative volumetric studies to validate outcome would of value.
I congratulate the authors on their manuscript titled “Dermal Onlay Grafts: A Rescue Procedure for Secondary Inferior Periorbital Hollows,” 1 which sheds light on an important yet challenging area of aesthetic surgery. The eyelid-cheek junction has long been an area of interest and controversy in facial surgery, with various techniques having been described ranging from excision of fat, to additional of fat/filler, to transposition of fat, or some combination of the above. Despite the vast clinical experience and data that have accumulated in our field related to this region, peri-orbital hollows remain a frustrating and difficult treatment area for both patients and physicians.
In the following manuscript, the authors introduce a novel approach to the lower eyelid-cheek junction using dermal…