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

Background: 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. Methods: 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. Results: 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. Conclusions: 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. ? 2011 Springer-Verlag.