The Treatment of Palpebral Bags by Repositioning of Orbital Fat into a Subperiosteal Pocket

Baggy eyelids or palpebral bags of the lower eyelids are mainly caused by weakening of the orbital septum, atrophy of the orbicilaris oculi muscle and slackness of the skin. These palpebral bags are usually combined with a depression along the inferior orbital rim which is called a tear trough groove and a tear trough groove can be divided into a nasojugal groove and a palpebromalar groove. Excision of the protruded orbital fat as a treatment for palpebral bags may contribute in the long term to the senile enophthalmos due to a volume reduction of the intraorbital adipose tissue. Authors treated palpebral bags and tear trough grooves by reposition of orbital fat flaps into a subperiosteal pocket of the inferior orbital rim. Myocutaneous flaps from the lower eyelids were elevated through subciliary incisions to expose the inferior orbital rim and subperiosteal pockets were made on the orbital rim. The orbital fat flaps protruded through the incised orbital septum near the arcus marginalis were repositioned into the subperiosteal pockets by two or three horizontal mattress sutures. Nine patients with palpebral bags and tear trough grooves were operated with this technique and follow-up range was between 6 to 14 months(an average of 11 months). Palpebral bags and tear trough grooves were corrected well and youthful looking eyes were obtained. The main advantages of this technique are that; the first, we can get wide operative field and easy repositioning of orbital fat into the subperiosteal pocket through the transcutaneous approach than the transconjunetival approach, the second, subperiosteal repositioning of the orbital fat can make more even and smooth skin surface over the periorbital region than the supraperiosteal repositioning of the orbital fat due to coverage of the irregular fat lobules by the periosteum and the third, lower blepharoplasty can be combined with this technique.

Clinical effect on baggy eyelid plasty: a report of 1 050 consecutive cases / 中华医学美学美容杂志

Objective To investigate a myocutaneous flap method for eyelid baggy plasty conforming to the medical aesthetic requirements. Methods Before operation the amount of the lower eyelid skin excised should be determined. Asking the patient to look upward at supine position, the operator lifted properly the lower eyelid skin using fine forceps without teeth at the results of smooth superficialness at this region and slight ectropion. The incision lines were marked along the print pinched by forceps and the trace 2 to 3 mm below the ciliary margin. Intra-operatively severing soft issues to the inferior orbital fringe just on the sub-orbicularis level, the skin-muscle flap was made. Then the excessive muscle was removed in the light of the incision lines. The orbital fat teased out resected or filled up the concavity along the lower orbital edge. Results The tense and smooth appearance of lower eyelid was archived in 900 cases received in our hospital except 2 temporary ectropion cases and 2 temporary double vision cases. We repaired the 15 ectropions using adjacent skin flap, tarsal reduction, skin soft tissue expansion, or superficial temporary fascia sling suspension, eliminated 28 haematomaes and made the excision of scar and wound suture for a hypertrophic scar case in the 150 complications from other hospitals. The crow wrinkles were improved apparently. Conclusion The amount of skin excision determined pre-operatively, which not only successfully refrains interfering elements from blooding and swelling but also avoids giving rise to ectropion, is accurate than that performed during operation. Natural appearance after operation becomes better and lasting because of orbicularis raised which strengthens the anterior wall of orbital septum.