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Transconjunctival Lower Eyelid Blepharoplasty with Fat Transposition Above the Orbicularis Muscle for Improvement of the Tear Trough Deformity.

BACKGROUND
The tear trough is the hollow concavity of the medial lower eyelid. Surgery can address tear trough deformities and reverse visible signs of periorbital aging. The previous methods of transconjunctival blepharoplasty with fat transposition were first described with subperiosteal placement of fat.1,2 This was followed by techniques with submuscular transposition of fat, which overcame certain difficulties associated with the subperiosteal methods.3,4 OBJECTIVES: We present a detailed description, evaluate the efficacy, safety, and advantages of transconjunctival blepharoplasty with fat pedicle transposition above the orbicularis muscle for lower eyelid rejuvenation and improvement of the tear trough deformity.


METHODS
41 patients underwent lower eyelid blepharoplasty with fat transposition above the orbicularis muscle. Clinical and photographic documentation along with patient satisfaction ratings were evaluated for a minimum of forty-four months post-operatively.


RESULTS
Significant improvements of lower eyelid aesthetics and correction of tear trough abnormalities were observed in most patients. At forty-four months post-operatively, surgical correction was maintained in all patients with a high satisfaction and long-term survival. No contour irregularities or significant long-term complications were detected in any of the patients.


CONCLUSION
Transconjunctival blepharoplasty with the fat pedicle transposition placed above the orbicularis muscle is a safe and effective technique for lower eyelid rejuvenation. Compared to previously described techniques of repositioning fat into the subperiosteal or submuscular plane, this technique of transposing fat above the orbicularis muscle is an alternative technique resulting in long term improvement of tear trough abnormalities with no major complications.