ABSTRACT
Objective:To investigate the clinical experience of using orbital fat pedicle to correct eyebags with the tear trough and palpebromalar groove deformity.Methods:From February 2020 to May 2021, 35 patients with lower blepharoplasty combined with orbital fat-release were treated in the Facial and Neck Plastic Surgery Center of the Plastic Surgery Hospital of Chinese Academy of Medical Sciences, including 4 males and 31 females. Their age ranged from 35 to 63 years, with an average age of 47.5 years. Different degrees of lower eyelid skin laxity, orbital fat herniation, moderate and severe tear trough, palpebromalar groove deformity were observed in all patients. Preoperative examination showed no symptoms such as lower eyelid ectropion and lower eyelid retreat ment. All 35 patients were treated with transcutaneous incision blepharoplasty, in which the orbital septal fat was released, pulled downward and internally fixed to the appropriate position to fill the tear trough and palpebromalar groove.Results:All patients obtained primary healing, no complications such as hematoma, and infection occured. Postoperative follow-up lasted from 3 to 18 months, with an average of 8.6 months. 35 patients′ eye bags with tear trough and palpebromalar groove deformity were obviously alleviated. Unilateral mild eye bag remained in 2 patients in postoperative 1 month, and 2 cases appeared mild lower eyelid ectropion postoperatively, none of these patients received special treatment and recovered after 3 months.Conclusions:Lower blepharoplasty combined with orbital fat release can effectively repair eye bags and correct tear trough and palpebromalar groove deformity.
ABSTRACT
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.