Guided Internal Fixation Technique for Transconjunctival Orbital Fat Transposition

The predominant method for transconjunctival orbital fat transposition is by conducting 1 or several temporary externalized sutures. A new method that could internally and more securely fixate the fat to the periosteum remains desirable. This manuscript introduces a technique that utilizes a titanium ring to guide transconjunctival orbital fat fixation for lower blepharoplasty. With 8 to 10 mm transconjunctival incisions, the orbicularis retaining ligaments were released. An intraoperatively made ring guided the sutures that was made transcutaneously and anchored on the periosteum to exit the preseptal space through the transconjunctival incision. The orbital fat graft was then fixated internally by this suture. From October 2017 to November 2019, 51 patients were included in this study. The mean patient age was 35.7 years (ranged 28-42 years). The mean operative time for the surgical procedure was 52 minutes. No major complications were noticed in any patients. There was 1 case in which the eye bag relapses at fifth week postoperatively, but was corrected by the same approach. At the average follow-up period of 12.1 months, all patients presented significant improvement of the lower eyelid cosmesis. Forty-four patients rated the aesthetic outcomes as "Very Satisfied," the other 7 rated "Satisfied" in a self-assessment questionnaire.Global Aesthetic Improvement Scale echoed similar outcomes. This guided internal fixation technique is technically practical when properly executed. It offers a new method for facilitating orbital fat transposition in lower blepharoplasty.