Transconjunctival Capsulopalpebral Fascia Fixation for the Correction of Orbital Fat Bulging

ABSTRACT

PURPOSE: The orbital fat bulging may cause irregular contour of lower eyelid, which is not youthful appearance. The conventional method of fat excision may cause the eyeball to move backward and downward, making enopthalmia is inevitable. The transcutaneous approach to reach the orbital septum can increase the risks of scleral show resulting from scarification at the level of the septum orbicularis junction and damaging the vertical motor branches of the preseptal orbicularis oculi muscle of the lower eyelid. METHODS: From July 2007 to March 2008, total of 21 patients underwent transconjunctival capsulopapebral fascia fixation procedure. In 8 patients, the herniated fat pad of the lower eyelid was relocated back into the orbit without external skin excision using capsulopalpebral fascia fixation. But in 13 patients, excision of redundant skin of the lower eyelid was performed using pinching technique, not involving orbicularis oculi muscle. In 5 patients, lateral canthotomy was done bilaterally for good visual field. In 6 patients, lateral canthopexy was also combined to correct loosening of lower eyelid. RESULTS: Most of the patients were satisfied after at least 5 months of follow up. No patient showed scleral show. But 2 patients complained of undercorrection slightly, without secondary operation in 1 patient and re- capsulopalpebral fascia fixtation through transconjunctival approach in another patient. CONCLUSION: Orbital fat repositioning using transconjunctival capsulopalpebral fascia fixation is a good procedure to maintain youthful appearance without increasing the risk of scleral show and also showed fast recovery compared to the conventional transcutaneous approach.