Experience of Fat Repositioning in Lower Eyelid Blepharoplasty

Abstract

TECHNIQUE The patient is marked preoperatively while awake. A transconjunctival incision is then made. Dissection is then performed in the plane between the orbicularlis muscles and orbital septum. The orbital septum is then detached from the arcus marginalis. The medial and central fat compartments are dissected (Figure 1). Fat is removed in select cases if an excess amount of fat is present. The dissected fat is then repositioned anterior and inferiorly in a supraperiosteal pocket over the malar bone. The suborbicularis fat along with the attached orbital septum are then secured with through and through absorbable bolster sutures that are removed postoperatively. (Figure 2) METHODS The medical records of a consecutive series of patients who underwent lower lid blepharoplasty with fat repositioning were reviewed. All procedures were performed by the senior author (AJ). Inclusion criteria were adult patients undergoing bilateral lower lid blepharoplasty for poor cosmetic appearance. Patients were not excluded if they had a history of prior lower blepharoplasty or if they were undergoing other simultaneous cosmetic procedures such as upper blepharoplasty. Records were reviewed for patient demographics, primary indications for procedure, and complications. Complications were defined as infection, hematoma, dry eye, ectropion, or entropion. Aesthetic complications were defined as asymmetry, scarring, and unfavorable cosmetic result.