Redraping of the fat and eye lift for the correction of the tear trough

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Abstract

Introduction

Tear trough deformity is very difficult to correct. It can appear at relatively young age and it deepens over the years due to laxity and loss of structural support.

We describe a technique for the correction of tear trough deformity and mid-face laxity by means of redraping blepharoplasty and lateral “eye lift”.

Materials and methods

Upper lid markings were made and removal of the excess skin was employed. The herniated fat was removed from the nasal fat pad.

Using a subciliary incision the dissection was completed at the level of the orbital rim and the fat was repositioned with 5-0 Monocryl (poliglecaprone 25, Ethicon) sutures at the inner canthus to correct the tear trough. Subsequently, a canthopexy performed to secure the lower eyelid. We then dissected the cheek over the periosteum of the zygomatic bone-arch and the flap was suspended through a tunnel at the periosteum of the upper-lateral orbit by 5-0 Monocryl (poliglecaprone 25, Ethicon) suture.

Results

Thirty-five procedures were performed between 2009 and 2013. Patients were followed for at least one year. Successful correction of the tear trough deformity with middle face elevation was achieved in all patients. Sclera show was noted in 7 patients but resolved over 3–6 months period with no surgical intervention. Diplopia was noted in 1 patient probably due to oedema and was released 4 weeks after the operation. The oedema was prolonged (more than 1.5 month) in 10 patients probably due to the lymphatic stasis. Conjunctivitis was also noted in 2 patients and was released by conservative treatment.

Conclusion

Our technique of redraping blepharoplasty and mid-face lift describes a relatively new approach for the correction of the tear trough deformity and middle face laxity. It shows stable results for up to 4 years although longer follow-up is needed to confirm the stability of the correction.

Introduction

The lower eyelids can become “tired” over the years and can be corrected by invasive or non-invasive procedures. “The tear trough” is the medial depression of the lower eyelid which worsens after the age of 30 and is very difficult to correct. Makeups, injection of hyaluronic acid or fat are temporary measures. Filler procedures will need to be repeated every six to nine months and the patient will be exposed to the risks and complications associated with filler procedures every time the procedure is performed. More permanent solutions include lipo-filling and mid-face lift (Mendelson, 1995, Yousif and Mendelson, 1995, Grabb and Smith's Plastic Surgery, 1997).

In this study we introduce an alternative approach for the correction of the tear trough and the sagging of the middle face. The technique involves redraping of the lower eyelid fat and suspension of the middle face to the lateral orbit of the upper eyelid.

The orbital septum is the anterior boundary of the orbit and its contents. It is a fibroelastic membrane and attaches to the lower orbital rim through the “arcus marginalis”.

The tear trough is the sharp definition between the cheek and lower lid and contains fat (prezygomatic fat as described by Mendelson, 1995).

Herniation of this fat with ageing can make tear trough more pronounced (Yousif and Mendelson, 1995), enhancing the dark cycles around the eyes.

The malar fat pad is a triangular subcutaneous structure based at the nasolabial fold with its apex at the malar eminence. It lies superficially to the Superficial Muscular Aponeurotic System (SMAS) (Yousif and Mendelson, 1995, Grabb and Smith's Plastic Surgery, 1997, Stuzin et al., 1992). Age related atrophy of this subcutaneous fat pad, results in the loss of the youthful, smooth transition between the lid and the lateral cheek.

The orbicularis oculi muscle may become flaccid and redundant which contributes to the formation of festoons. The anterior displacement of the orbital fat contributes finally to the lower eyelid bags (Hester et al., 2001).

Section snippets

Material and methods

Thirty-five patients were operated by the same Surgeon between 2009 and 2013 (at OpsisClinical, Plastic and Reconstructive Surgery, Heraklion-Crete, Greece). This was a prospective non-randomized clinical study, informed consent was obtained from all patients, none of them had prior blepharoplasty and they were aged from 33 to 68 years old. All the patients were asked to complete a questionnaire (from one to five) in order to note their satisfaction (Table 1). Student's t-test (p < 0.05), was

Results

The tear trough deformity and mid-face laxity was dramatically improved in all patients. The complications seen were not significantly higher than those for standard transcutaneous blepharoplasty techniques (Grabb and Smith's Plastic Surgery, 1997, Stuzin et al., 1992, Hester et al., 2001), except from the oedema which was released in all the cases. Diplopia was noted in 1 patient probably due to oedema and was released 4 weeks after the operation. Scleral show was noted in 7 patients but

Discussion

In blepharoplasty patients, orbital fat excision or fixation has been used to optimize the result. Furnas (1978), was the first to describe the resection of the orbicularis muscle and suspension of the lower eyelid to the lateral orbital rim. An alternative approach of excision of the herniated fat and placation of the orbital septa described by Huang (2000). Adamson et al., (1991) extended the dissection of the skin-muscle flap below the infraorbital rim. Hamra (1992) and Hamra (1998), was the

Conclusion

In this study we describe an effective technique for the correction of both, tear trough deformity and mid-face laxity. The fat redraping and lateral “eye lift” have stable results with some follow-up extending out to four years. Longevity of results is similar or better than those expected with standard blepharoplasties, as the modified technique creates lifting of the tissues.

Acknowledgement

The authors have nothing to disclose.

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