Aesthetic Plastic Surgery

, Volume 43, Issue 3, pp 695–701 | Cite as

Treating Tear Trough Deformity: Transconjunctival Blepharoplasty with Fat Pad Repositioning and Fixation in the Intranasal Mucosa—18 Years’ Experience

  • Caio Pundek GarciaEmail author
  • Ana Zulmira Diniz Badin
Innovative Techniques Oculoplastic



With aging, progressive changes occur in the eyelid region. The novel technique for repositioning of the fat pads described herein addresses Hester classification type II, lower eyelid aging with minimal decrease in the eyelid/cheek juncture.

Materials and Methods

In this retrospective study of patients undergoing surgery at our clinic between 2000 and 2018, 92 were classified as Hester II and a transconjunctival surgical procedure was performed with repositioning of the fat pads and intranasal fixation assisted by the Casagrande needle.


Erasure of the nasojugal fold was observed in all patients, offering a greater uniformity in the convexity of the middle third and resulting in better rejuvenation of the target area while eliminating visible scarring from a suture through the skin.


The repositioning of fat pads using intranasal fixation offers the necessary anchoring qualities without worrying about unsightly scars or the need to remove stitches early, which can decrease the proper scarring and adhesion of the pads in their new pockets.


The quality and longevity of the results of this retrospective study allow us to offer this novel fat pad fixation method in transconjunctival blepharoplasty.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Eyelid Blepharoplasty Tear trough Nasojugal sulcus Fat pad 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Supplementary material 1 (WMV 66510 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Division of Plastic SurgeryUniversity Hospital of Santa CatarinaFlorianópolisBrazil
  2. 2.Clinica AthenaRua Desembargador Vieira CavalcantiCuritibaBrazil

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