Percutaneous External Fixation of Redistributed Orbital Fat in Transcutaneous Lower Eyelid Blepharoplasty

Abstract Background Although percutaneous external fixation has gained popularity in transconjunctival blepharoplasty due to its simplicity and minimal incision, internal fixation remains the standard approach in transcutaneous blepharoplasty. Objectives The aim of this study was to assess the safety and effectiveness of percutaneous external fixation specifically in transcutaneous fat repositioning blepharoplasty. Methods A consecutive cohort of 97 patients underwent this surgical technique between May 2022 and December 2023. Building upon the principles of transconjunctival fat repositioning, the procedure involved a minimal incision targeting the muscle layer, a conservative release of the tear trough ligament, and the repositioning of fat secured with percutaneous external fixation. Surgical outcomes were evaluated using the Barton grading system and FACE-Q scales for patient-reported outcomes. Results Following a mean follow-up of 7.2 months (range, 6-17 months), a resolution of tear trough deformities and eyelid bags was achieved in over 92% of cases. Notably, significant improvements (P < .05) were observed in lower eyelid aesthetics as measured by the FACE-Q scale, with a concomitant enhancement in patients’ social confidence (P < .05). Overall, patients expressed satisfaction with their decision to undergo the procedure (71.0 ± 19.1). Complications necessitating revision surgery included isolated cases of hematoma evacuation, fat injection, excision of excess fat, and skin excision. Conclusions External fixation in transcutaneous blepharoplasty is technically less complex and minimally invasive, effectively securing transposed fat pedicles safely, and presents a viable alternative to conventional fixation techniques. Level of Evidence: 4 (Therapeutic)