Correction of Nasojugal Groove With Tunnelled Fat Graft

Abstract

Pronounced nasojugal sulcus (tear trough deformity) is a frequent and distressing symptom in aesthetic palpebral surgery. The sliding fat technique using the transcutaneous or transconjunctival approach has proven to be considerably useful in patients with clinically evident fat bags. In the absence of fat bags, commonly used techniques can lead to unpredictable (and frequently less than optimal) results. The authors report their experience with correcting the nasojugal groove in the absence of palpebral fat bags by use of a one-piece, free fat graft as an alternative to autologous fat injections or the placement of alloplastic materials. The authors conducted a retrospective study of a consecutive series of 34 patients (33 women and one man) between 42 and 57 years of age. In all cases, small, free fat grafts harvested from the medial fat compartment of the upper eyelid were placed precisely under the depression through two stab incisions in the suborbicularis plane, filling in the groove. Results were considered excellent in 24 out of the 34 patients. Results in the remaining 10 patients were rated as good, in most cases because of mild undercorrection. All patients expressed a high degree of satisfaction. Recovery time was very short and no eye or eyelid complications were observed. Correction of the nasojugal groove with a tunnelled fat graft causes minimal tissue trauma and allows exact placement of the graft. The upper palpebral fat has unique characteristics that render it an ideal graft material for correction of the nasojugal groove in patients with no concomitant lower fat bags. This procedure offers more predictable results and a lower incidence of adverse effects than more commonly used techniques.