What it means for a patient
- Puffy lower lids with a hollow groove below them can be treated by moving the fat into the groove instead of removing it.
- The incision is inside the eyelid.
- A temporary stitch through the skin holds the fat in position and comes out after 3 to 5 days.
- Some of the moved fat shrinks over time, by a variable amount.
- The author judged the texture and contour of the moved fat after a healing period of 1 to 2 months.
- Limits: a series of 24 patients with no comparison group and no measured outcomes in the abstract.
Why this paper matters
It described rotating orbital fat pedicles into a subperiosteal pocket through a transconjunctival approach to treat the tear trough deformity.
Overview
Lower eyelid aging involves bulging orbital fat and descent of the cheek tissue, which makes the orbital rim and the tear trough groove more visible. When a deep groove runs along the orbital rim, the author repositions the fat over the rim instead of removing it. The operation is done through the conjunctiva, the inner lining of the eyelid.
Findings
- Approach: transconjunctival, through the inside of the lower eyelid.
- The arcus marginalis is exposed and cut, and a subperiosteal pocket is made over the upper face of the maxilla.
- The pocket's shape and location are customized to where the fat should sit; the origins of the levator labii superioris and levator alae nasi muscles are often partly dissected.
- Medial and central fat pedicles are rotated over the orbital rim into the pocket.
- A 6-0 polypropylene suture brought out through the skin holds each pedicle in place and is removed after 3 to 5 days.
- 24 patients were followed for 6 to 30 months.
- The fat pedicle undergoes some variable resorption.
- The author cites graft viability, the texture and contour of the fat after 1 to 2 months of healing, and high patient acceptance as evidence the method works.
- The abstract gives no complication rates and no measured contour change.
Terms
- Orbital fat: the fat around the eyeball that can bulge forward into the lower eyelid.
- Tear trough deformity: a groove running from the inner corner of the eye down and out along the orbital rim.
- Transconjunctival: through the conjunctiva, the pink lining on the inside of the eyelid.
- Arcus marginalis: the band at the orbital rim where the lining of the eye socket joins the bone lining of the face.
- Subperiosteal: beneath the periosteum, the thin layer covering bone.
- Maxilla: the upper jaw and cheek bone below the eye.
- Pedicle: a piece of tissue moved while still attached to its blood supply.
- Resorption: the body's gradual breakdown and absorption of tissue.