Lower eyelid transconjunctival blepharoplasty with fat repositioning: outcomes and complications

Abstract

Background

The lower eyelid changes with aging include atrophy of the orbital septum with subsequent forward herniation of orbital fat, descent of the sub-orbicularis oculi muscle fat, ptosis of the orbicularis oculi muscle, weakening of the orbito-malar ligament and the development of laxity of the eyelid skin, the tarsus and the canthal tendons. In this article we aim at describing our experience of using a modified lower lid blepharoplasty with fat repositioning in patients with lower lid fat prolapse and tear trough deformity.

Methods

A retrospective, non-randomised non-comparative interventional consecutive case series of patients seeking surgical treatment. Patients underwent surgery between April 2010 and October 2019 by a single surgeon (BL). Patient demographics, clinical examination, preoperative and postoperative clinical photography, outcomes and complications were recorded. Follow-up was initially at 2 weeks and finally at 16–20 weeks. Outcomes were recorded as subjective improvement and degree of patient satisfaction.

Results

A total of 150 patients were recruited in the study period. The mean age at the time of surgery was 49. One hundred forty-one (94%) patients were very satisfied with the final outcome of their surgery, 5 were satisfied and 4 were dissatisfied. One patient developed a bilateral lower lid infection requiring abscess drainage. Seventeen other patients experienced minor complications in the postoperative period, including 2 with a unilateral lower lid infection requiring oral antibiotics, 3 with a temporary inferior oblique palsy, 1 with temporary unilateral infraorbital nerve dysfunction, 3 with residual prolapses of the lateral fat pads, 1 with a medial lower lid lump, 2 with a conjunctival granuloma, 2 with a temporary medial ectropion, 1 with persistent unilateral lower lid oedema, 1 with persistent bilateral lower lid oedema and 1 with unilateral lower lid retraction.

Conclusions

We report a high patient satisfaction with a low rate of significant complications following our modified lower lid transconjunctival blepharoplasty with fat repositioning.

Level of evidence: Level III, therapeutic study

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Correspondence to Paul S. Cannon.

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The authors declare that they have no conflict of interest.

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This retrospective study of case series did not require ethical approval from the Institutional Review Board, although it did adhere to the tenets of the 1964 Declaration of Helsinki.

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Written informed consent was obtained from all patients for the use of clinical images and from Thieme Publications for images used.

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Cannon, P.S., Leatherbarrow, B. Lower eyelid transconjunctival blepharoplasty with fat repositioning: outcomes and complications. Eur J Plast Surg 43, 719–726 (2020). https://doi.org/10.1007/s00238-020-01671-7

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Keywords

  • Lower lid blepharoplasty
  • Fat repositioning
  • Complications
  • Outcomes
  • Satisfaction