Fat Repositioning With a Combination of Internal Fixation and External Fixation in Transconjunctival Lower Blepharoplasty
Various methods on transconjunctival fat repositioning have been promoted to treat tear trough deformities in patients with eye bags.
The authors present a modified approach based on the facial soft-tissue spaces with the combined fixation method.
A total 226 patients underwent this procedure. Through a preseptal approach, the premaxillary and prezygomatic spaces were sequentially separated. Orbital fat was repositioned into the spaces together with the septum. The proximal part of the septum-fat flap was sutured to orbital rim with internal fixation, and their distal stumps were fixed to the end of the soft spaces with externalized percutaneous sutures. Surgical outcome was assessed by surgeons based on Hirmand’s grading system. Patients’ satisfaction and quality of life were measured using FACE-Q scales. Magnetic resonance imaging was employed to assess the long-term fate of the transposed fat.
Tear trough deformities were eliminated in 86.7% of cases. Scores of lower eyelid FACE-Q decreased significantly (P < 0.05). Patients demonstrated enhanced social confidence (P < 0.05) and high satisfaction (74.3 ± 17.2) and were satisfied with their decision to undergo blepharoplasty (78.2 ± 18.7). Undercorrection occurred in 1 patient. Additional complications included transient granulomas, dye eye, unexplained swelling, and numbness, which resolved in all patients. Magnetic resonance imaging confirmed viability of the transposed fat within 6 to 8 months follow-up.
Transconjunctival fat repositioning, utilizing a combination of internal fixation and external fixation, is an effective approach to treat eye bags and tear trough deformities with good patient and surgeon satisfaction.
This is a well-written report on a novel technique of fat flap fixation during transconjunctival lower blepharoplasty with fat repositioning (TCBFR).1 As a specialty surgeon (oculoplastic surgery) I have had the opportunity to perform high volumes of TCBFR for the last 20 years. I have attempted every permutation of the procedure and have settled on what in my hands is the safest, most consistent, and most reproducible variant: a retroseptal approach involving subperiosteal fat redraping with external suture fixation.2 Given this, I appreciate all efforts at advancing and improving outcomes to this common procedure which has shown such great utility in effacing lower eyelid-cheek interface depressions.3 In this vein, I congratulate the authors on their work, and,…