Lower Blepharoplasty by Repositioning of Orbital Fat

ABSTRACT

Palpebral bag of the lower eyelid & tear trough groove is regarded as a sign of aging. This is mainly caused by weakening of the orbital septum, atrophy of the orbicularis oculi muscle and slackness of the skin. This palpebral bag is usually combined with a depression along the inferior orbital rim which is called a tear trough groove. In the past, the surgical excision of the fat pad has been the mainstay of the management of lower palpebral bag in cosmetic blepharoplasty. But, excision of the protruded orbital fat as a treatment for palpebral bag may contribute in long term to the senile enophthalmos due to a volume reduction of the intraorbital adipose tissue. Recently, fat pad sliding method with septal incision has been performed for preservation of orbital fat. This technique, however, causes problems such as lid ecchymosis, chemosis, lid contour irregularity, ectropion, and retrobulbar hematoma formation. The authors propose to restore the functional integrity of orbital septum. Attenuated orbital septum with orbital fat was stretched and transposed to cover the bony framework. The orbital septum with orbital fat meticulously sutured to the periosteum of inferior orbital rim with 5-0 nylon. This technique of septal draping over the inferior orbital rim was performed in 54 consecutive individuals(108 lower eyelids) for 27 months period. The overall results obtained, with the exception of mild degree of puffiness encountered soon after the surgery, were satisfactory and morbidity was minimal.