Extended transconjunctival lower blepharoplasty safe, effective for tear trough deformity, eye bags
An extended transconjunctival lower blepharoplasty using soft-tissue spaces in the midcheek is both safe and effective for eye bags and tear trough deformity, according to a new study.
The study included 54 patients who received eye bag removal with fat redistribution and tear trough release. Of these, 96 percent (n=52) were primary cases, while a further 53 percent (n=29) underwent lower blepharoplasty together with fat grafting to the midcheek.
Briefly, the surgical procedure first involved removal of excess orbital fat pads from the preseptal space through a transconjunctival incision. The procedure was performed under either local or general anaesthesia.
The following were then sequentially released: the palpebral part of the orbicularis oculi, the tear trough ligament and the orbital part of the orbicularis oculi. This will reveal the levator labii superioris fibres. The medial part of the orbicularis retaining ligament is also released.
The tear trough deformity was then addressed by subsequently grafting the removed fat under the tear trough ligament.
In terms of outcomes, the mean operative time was 42 minutes for the lower eyelid alone, while fat grafting required an additional 25 minutes. Over a mean follow-up period of 10 months, three patients required surgical revisions yielding a revision rate of 5 percent.
Nine percent (n=5) of the patients reported lumpiness of the fat grafts, all of which were resolved spontaneously within 8 weeks. One patient reported a haematoma while another had a corneal abrasion; both cases resolved spontaneously. No cases of chemosis, prolonged swelling, ectropion or eyelid retraction were observed.