Simple Approach for Internal Fixation of Repositioned Fat Pedicles in Transconjunctival Lower Eyelid Blepharoplasty

Purpose: To introduce an easy and effective approach for internal fixation of repositioned fat pedicles in transconjunctival lower eyelid blepharoplasty. Methods: Thirty-six consecutive patients underwent fat repositioning transconjunctival lower blepharoplasty from August 2016 to January 2018. After release of the orbicularis oculi muscle and exposure of the intraorbital fat pedicles, a supraperiosteal pocket was dissected. A 6-0 nylon suture was passed through the shaft of a hypodermic needle from the sharp tip, then the hypodermic needle was pierced through the cheek skin about 5 to 8 mm below the orbital rim into the dissected pocket, the hypodermic needle was next pull out and pierced through the same pinhole but different pathways into the dissection pocket again. The hypodermic needle was curved accordingly and passed through the lower surface tissue of the pocket, the needle was then taken out. Two ends of the 6-0 nylon suture were both brought out through the transconjunctival incison. One end of the 6-0 nylon suture was sewed through the free margin of the fat pedicle and tied tightly with the other end. The fat pads were transferred and blended well with midface fat. The severity of tear trough deformity were evaluated according to Barton's grading system by two independent plastic surgeons pre and post-operatively. Results: Tear trough deformity was improved in most cases. There were significant differences in preoperative and post-operative tear trough deformity grades (P < 0.5). All patients recover very well without significant complications. Three patients had transient mild to moderate lumpiness over the tear trough area, which were all resolved spontaneously eventually. One patient complained of retained fat tissue, and a revision surgery was given. Conclusions: In summary, The authors offered a new, simple, and effective approach to help fix the repositioned fat pads in transconjunctival lower lid blepharoplasty.