Internal Fixation of Redistributed Orbital Fat in Transconjunctival Lower Eyelid Blepharoplasty

Fat redistribution combined with release of the tear trough ligament in transconjunctival lower blepharoplasty is widely performed to correct lower eyelid bags and tear trough deformities, but the method of suturing the released fat in such a narrow, dissected space remains a challenge during the procedure. The purpose of this study was to introduce a new surgical technique of internal fixation that advances and sutures the pedicled orbital fat firmly to the midcheek through premaxillary and prezygomatic spaces. Twenty-two patients (range, 22 to 39 years) diagnosed with predominant orbital fat prolapse and tear trough deformity without noticeable lower eyelid skin laxity were treated with this method, all of whom presented impressive correction of the eyelid bags and tear trough deformities and were aesthetically pleased during an average follow-up of 11.8 months (range, 10 to 14 months). No patients complained about postoperative hematoma, ectropion or midface numbness. The maneuver of internal fixation of redistributed orbital fat provides a novel and safe approach to correct eyelid bags and tear trough deformities without additional percutaneous sutures in transconjunctival lower eyelid blepharoplasty.