Fat repositioning via supraperiosteal dissection with internal fixation for tear trough deformity in an Asian population

  • Shu Lang Liao
  • Yi Hsuan Wei
Oculoplastics and Orbit



To investigate the efficacy and complications of fat repositioning via supraperiosteal dissection with internal fat-flap fixation for tear trough deformity in an Asian population.


This study is a retrospective chart review. From June 2005 to May 2010, 212 patients with lower eyelid fat prolapse and tear trough deformity underwent fat repositioning via supraperiosteal dissection with internal fat-flap fixation. Postoperative complications were recorded, and the degree of outcome satisfaction was obtained at the 6-month postoperative follow-up.


In total, 142 patients underwent transconjunctival fat repositioning, and 70 received the transcutaneous approach for redundant lower lid skin and tear trough deformity. The level of satisfaction 6 months after the operation was high: 152 patients rated their experience as very satisfied (71.7%), 54 as satisfied (25.5%) and six as acceptable (2.8%). None reported being dissatisfied or unhappy. No diplopia or evidence of granuloma formation in the lower eyelid or check area was noted. Four patients who suffered from significant ecchymosis and conjunctival chemosis with corneal exposure were managed with lubricants and resolved spontaneously. Three patients who underwent the transcutaneous approach and excess skin excision had the complication of lower lid ectropion; they received lateral tarsal strip procedures with good results. Three patients required revision to remove the residual lateral fat pad because of inadequate lateral orbital fat excision during the initial procedure.


Fat repositioning via supraperiosteal dissection with internal fat-flap fixation is a safe and effective method to create a youthful midface appearance for Asians with tear trough deformity.


Tear trough deformity Fat repositioning Supraperiosteal dissection 


Conflict of interest

Neither author has a financial or proprietary interest in any material or method mentioned.

Supplementary material


(MPG 41.6 MB)


  1. 1.
    Hamra ST (1995) Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 96:354–362PubMedCrossRefGoogle Scholar
  2. 2.
    Mendelson BC, Muzaffar AR, Adams WP Jr (2002) Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg 110:885–896PubMedCrossRefGoogle Scholar
  3. 3.
    Flowers RS (1993) Tear trough implants for correction of tear trough deformity. Clin Plast Surg 20:403–415PubMedGoogle Scholar
  4. 4.
    Goldberg RA (2000) Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 105:743–748PubMedCrossRefGoogle Scholar
  5. 5.
    Carter SR, Seiff SR, Choo PH, Vallabhanath P (2001) Lower eyelid CO2 laser rejuvenation: a randomized, prospective clinical study. Ophthalmology 108:437–441PubMedCrossRefGoogle Scholar
  6. 6.
    Baker SR (1999) Orbital fat preservation in lower-lid blepharoplasty. Arch Facial Plast Surg 1:33–37PubMedCrossRefGoogle Scholar
  7. 7.
    Mohadjer Y, Holds JB (2006) Cosmetic lower eyelid blepharoplasty with fat repositioning via intra-SOOF dissection: surgical technique and initial outcomes. Ophthal Plast Reconstr Surg 22:409–413PubMedCrossRefGoogle Scholar
  8. 8.
    Hamra ST (1996) The role of orbital fat preservation in facial aesthetic surgery. A new concept. Clin Plast Surg 23:17–28PubMedGoogle Scholar
  9. 9.
    Eder H (1997) Importance of fat conservation in lower blepharoplasty. Aesth Plast Surg 21:168–174CrossRefGoogle Scholar
  10. 10.
    Goldberg RA, Edelstein C, Balch K, Shorr N (1998) Fat repositioning in lower eyelid blepharoplasty. Semin Ophthalmol 13:103–106PubMedCrossRefGoogle Scholar
  11. 11.
    Goldberg RA, Edelstein C, Shorr N (1999) Fat repositioning in lower blepharoplasty to maintain infraorbital rim contour. Facial Plast Surg 15:225–229PubMedCrossRefGoogle Scholar
  12. 12.
    Wu CH, Chang TC, Liao SL (2008) Results and predictability of fat-removal orbital decompression for disfiguring Graves exophthalmos in an Asian patient population. Am J Ophthalmol 145:755–759PubMedCrossRefGoogle Scholar
  13. 13.
    Loeb R (1981) Fat pad sliding and fat grafting for leveling lid depression. Clin Plast Surg 8:757–776PubMedGoogle Scholar
  14. 14.
    Loeb R (1993) Nasojugal groove leveling with fat tissue. Clin Plast Surg 20:393–400PubMedGoogle Scholar
  15. 15.
    Coleman SR (1997) Facial contouring with liposculpture. Clin Plast Surg 24:347–367PubMedGoogle Scholar
  16. 16.
    de la Plaza R, Arroyo JM (1988) A new technique for the treatment of palpebral bags. Plast Reconstr Surg 81:677–687PubMedCrossRefGoogle Scholar
  17. 17.
    Nassif PS (2005) Lower blepharoplasty: transconjunctival fat repositioning. Facial Plast Surg Clin North Am 13:553–559PubMedCrossRefGoogle Scholar
  18. 18.
    Kawamoto HK, Bradley JP (2003) The tear “TROUF” procedure: transconjunctival repositioning of orbital unipedicled fat. Plast Reconstr Surg 112:1903–1907PubMedCrossRefGoogle Scholar
  19. 19.
    Momosawa A, Kurita M, Ozaki M, Miyamoto S et al (2008) Transconjunctival orbital fat repositioning for tear trough deformity in young Asians. Aesthet Surg J 28:265–271PubMedCrossRefGoogle Scholar
  20. 20.
    Goldberg RA, Yuen VH (2002) Restricted ocular movements following lower eyelid fat repositioning. Plast Reconstr Surg 110:302–308PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of OphthalmologyNational Taiwan University Hospital, College of Medicine, National Taiwan UniversityTaipeiTaiwan

Personalised recommendations