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In order to fully demonstrate the clinical significance of the article " Correction of palpebral bags and tear trough deformity by orbital fat repositioning through premaxillary and prezygomatic space with intraoral fixation" [Gao Wei, Lin Xiaoxi, Jin Yunbo, et al.Chin J Plast Surg, 2019, 35(12): 1240-1245], the editor invited professor Xiaolei Jin to write a discussion/review on this paper. Professor Xiaolei Jin affirmed the innovation and practicability of this technique in solving the problem of " the infraorbital edema with mid-face depression" , and proposed that the following questions should be investigated further: (1) indications and contraindications for this procedure.(2) the technical details of the transfer and fixation of orbital septal fat flap.(3) issues for controlling the potential risk of infection. (the editor)
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Objective@#To explore and evaluate the approach of fat repositioning into premaxillary and prezygomatic spaces combined with intraoral fixation in transconjunctival lower blepharoplasty.@*Methods@#17 patients (2 males and 15 females) who underwent this approach from Aug, 2018 to Feb, 2019 were reviewed. Their average age was 36.88±8.80 years old (range, 24 to 55 years old). A 1.0-1.5 cm transverse transconjunctival incision was made. After blunt dissection of premaxillary and prezygomatic spaces, orbital fat were released and sutured with 1-2 absorbable sutures. Via the guidance of astraight needle through the a forementioned spaces, a small incision was made at the upper vestibular labial side. The orbital fat was pulled down according to the consensus between surgeon and patient and fixed upon the small intraoral incision. All incisions didn′t need to be sutured.@*Results@#The mean follow up was 3.53±1.71 months (range, 1 to 6 months), transconjunctival and intraoral incisons healed well. Palpebral bags and tear trough deformity were obviously improved. Postoperatively, 2 patients felt a transient tractive feeling in the midface region 1 week after surgery, which spontaneously recovered within 1 to 2 weeks. One patient had red, swollen and painful skin beside the right nasal alar one month after the operation, and the symptoms disappeared after 3-day intravenous infusion of cefradine. No lower eyelid retraction, ectropion, hematoma and other complications were observed.@*Conclusions@#This novel approach can achieve periorbital rejuvenation and improve the contour of the lower eyelid and mid-face for patients of all the ages with eyelid bags, tear trough deformity, and midfacial depression, but without severe skin laxity.
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Objective@#To explore and evaluate the approach of fat repositioning into premaxillary and prezygomatic spaces combined with intraoral fixation in transconjunctival lower blepharoplasty.@*Methods@#17 patients (2 males and 15 females) who underwent this approach from Aug, 2018 to Feb, 2019 were reviewed. Their average age was 36.88±8.80 years old (range, 24 to 55 years old). A 1.0-1.5 cm transverse transconjunctival incision was made. After blunt dissection of premaxillary and prezygomatic spaces, orbital fat were released and sutured with 1-2 absorbable sutures. Via the guidance of astraight needle through the a forementioned spaces, a small incision was made at the upper vestibular labial side. The orbital fat was pulled down according to the consensus between surgeon and patient and fixed upon the small intraoral incision. All incisions didn′t need to be sutured.@*Results@#The mean follow up was 3.53±1.71 months (range, 1 to 6 months), transconjunctival and intraoral incisons healed well. Palpebral bags and tear trough deformity were obviously improved. Postoperatively, 2 patients felt a transient tractive feeling in the midface region 1 week after surgery, which spontaneously recovered within 1 to 2 weeks. One patient had red, swollen and painful skin beside the right nasal alar one month after the operation, and the symptoms disappeared after 3-day intravenous infusion of cefradine. No lower eyelid retraction, ectropion, hematoma and other complications were observed.@*Conclusions@#This novel approach can achieve periorbital rejuvenation and improve the contour of the lower eyelid and mid-face for patients of all the ages with eyelid bags, tear trough deformity, and midfacial depression, but without severe skin laxity.
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Objective@#To investigate the clinical effect of subcutaneous injection of nanofat combined with autologous fat into tear trough deformity to improve the mixed dark circle at lower eyelid, and the feasibility of using L*a*b* value to objectively evaluate the improvement of skin color at the lower eyelid with dark circle.@*Methods@#A total of 14 patients with the mixed dark circle at lower eyelid, admitted by Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from November 2017 to August 2018 were selected. They were all female, aged between 21 and 46 years old. Thigh or abdomen was selected as the fat donor area. Autologous fat was filled into the tear trough deformity. The prepared nanofat was injected into the subcutaneous layer of the lower eyelid with dark circle. Photoes were taken under the same condition and same room temperature for patients before operation and 6 months after operation. Photoshop, CS7 exposure correction, as well as 64 Image J software measurement were adopted to evaluate the skin L* a* b* value at dark circle of lower eyelid. SPSS 20.0 rows of data statistical analysis was applied with paired t test(P<0.05).@*Results@#All patients were followed up for 6 months after the operation, and a satisfactory effect was achieved after one injection, with an overall satisfaction rate of 78.6% (11/14). The color and skin fine wrinkles at the dark circle of the lower eyelid were improved in 14 patients, and the contour of the injection area was smooth without obvious complications. 6 months after the operation, the L* value of the skin at the lower eyelid with dark circle was 55.13±5.56, which was 7.74±2.39 higher than the preoperative value of 48.23±5.63, showing significant difference(t=12.089, P=0.00). Six months after surgery, the a* value was 14.68±2.84, which decreased by 0.11±0.60 compared with 14.79±3.04 before surgery, showing no statistically difference(t=-0.71, P=0.49). Six months after surgery, the b* value was 19.77±3.45, which increased by 0.27±1.03 compared with 19.50±3.45 before surgery, showing no statistical difference (t=0.98, P=0.35).@*Conclusions@#Subcutaneous injection of nanofat combined with autologous fat injection for tear trough deformity is effective in the treatment of lower eyelid with mixed dark circle. The L*a*b* value can objectively evaluate the improvement of skin color at the lower eyelid with dark circle.
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Objective@#To discuss the orbital fat autograft for lower baggy eyelid with tear trough deformity and its therapeutic effect through tranconjunctival approach.@*Methods@#The patients with lower eyelid bag and tear trough deformity were included into the study. The included 32 patients met the following criterias: ①less than 40 years old; ②lower eyelid skin was not relaxed; ③less than 1 s in Snap test; ④Hirmand type Ⅰ and Ⅱ. They were treated with tranconjunctival lower blepharoplasty combined with the tears ligament relaxation. The orbital fat was repositioned on the depression site above orbital periosteum to correct tear trough deformity. The effect was evaluated through Tear Trough Rating Scale (TTRS) and satisfaction degree.@*Results@#Three cases with Hirmand type Ⅱ didn’t have good effect. Among them, the baggy eyelid was corrected in 2 cases, while the tear trough deformity need additional hyaluronic acid injection. One patient underwent secondary lower blepharoplasty through cutaneous incision. Good effect was achieved in the other 29 cases with no depression deformity and eyelid withdrawal. The TTRS scores 6 months after operation was significantly improved(P<0.01). Satisfaction degree was 100%(14/14) and 83.3%(15/18) in type Ⅰ and Ⅱ patients.@*Conclusions@#The technique can simultaneously improve lower eyelid bag and the tear trough deformity. It can be applied in periorbital rejuvenation for middle-aged and young patients.
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Objective To study the mechanism of tear trough deformity and palabromalar groove deformity.Methods Four old cadavers (2 male,2 female,an average age of 67.2 years) with obvious tear trough deformity and palpbromalar groove deformity and 4 young cadavers (2 male,2 female,an average age of 23.5 years) without tear trough deformity and palpbromalar groove deformity were selected and dissected and histological observation were performed on lower eyelid and periorbital region.Results Compared to young specimens,the skin and orbicularis oculi muscle of old specimens were atrophy and relaxed.Tear trough deformity and palabromalar groove deformity overlaid the junction of thinner eyelid skin and thicker cheek skin.The superior border of the malar fat pad covered the junction of the palpebral and orbital portions of the orbicularis muscle,and correlated with the tear trough and palpbromalar groove,but the superior border of the malar fat pad in young cadavers was found above the tear trough and palpbromalar groove line.The orbicularis retaining ligament arose from the orbital rim and caudal to the junction of the palpebral and orbital portions of the orbicularis muscle,and it was relaxed in old group than that in young group.Conclusions Tear trough deformity and palabromalar groove deformity result from combination of age-related relaxation,atrophy and descent of layers of tissues.The orbital septal and the orbicularis retaining ligament prevent tissues from descending,which makes tear trough deformity and palabromalar groove deformity more visible.