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   OZ (2016-01-12 14:02:51, Hit : 4846, Vote : 98)
   Transconjunctival fat transfer
transconjunctival fat transfer

Studies have shown that people infer age based on visual cues from around the eyes.
Age related changes in the periorbital tissues, under eye bags, and wrinkles have a significant impact on the perceived age of an individual.

Long time ago, most surgeons thought simply that lower eyelid fat increases with age and should be removed.
So, only bulging fat was removed.
If there was redundant skin and muscle, they were removed and tightened.
This kind of simple fat removal can make lower eyelid even immediately, but the result doesn't last long because the underlying causes are not fixed properly.
In addition, too much removal of fat left lower eyelid hollowed out appearance that, paradoxically, created a more aged appearance.

Later studies find out the signs of aging in lower eyelid are more complicated and there are many underlying causes.
As people get old, midface and lower eyelids shows the sign of aging first.
Tear trough deepens in the lower eyelids as a hollow immediately below the lower eyelid fat bags because of lack of fat and soft tissue at that area and strong osseocutaneous ligament, termed tear trough ligament.
Lower eyelid fat protrudes because of attenuation of periorbital tissue like orbital septum, descent of globe, downward displacement of midface tissue.
Orbit becomes longer and maxilla becomes shorter and midface tissue moves downward.
These kinds of aging is happened by the influence of midface volume loss and gravitation.

So, nowadays, surgeons prefer preserving the fat and use it to fix the underlying causes instead of removing it.
Fat transfer or fat transpositioning shows better results in shorterm and longterm and lessen the complication also.
In fat transfer, osseocutaneous ligament from orbital margin and skin are cut and lower eyelid fat is transposed to ouside of orbit to fill up tear trough depression.
The interposed fat prevents reattachment of osseocutaneous ligament.
Becaues fat was moved outside of septum, lower eyelid fat bulging is disappeared of course.
The transposed fat has continuous blood supply and is not absorbed and maintains the volume eternally.
Because fat transfer treat underlying causes of lower eyelid aging, the result is better and lasts longer.

transconjunctival fat transfer

Transconjunctival technique of lower blepharoplasty has some advantages over transcutaneous techniques; reduced rate of lower lid malposition like eversion, improved healing, less irregularity, and concealed incision with no scar.
Because the middle layer of lower eylid is not touched, lower eyelid eversion is much less happened.
Because it touches only necessary portion of lower eylid, healing is much faster, irregularity is not happened, more natural appearance is made.
Because the incision is made at conjunctiva, it doesn't leave any scar.

Many patients think this kind of transconjunctival fat transfer is only indicated in relatively young women with mild fat bulging.
But it is not true.
It can be recommended to most of patients
When there is redundant skin and muscle, they can be removed separately with transconjunctival fat transfer.

Transcutaneous approach sometimes injures preseptal muscle(just beneath lower eyelash) and make upper margin of lower flat and make them look older and tired.
When it makes scar at orbital muscle and septum, lower eyelid can be everted.
Healing takes more time, hypertrophic scar can be happened, and unnatural shape or expression can be made.

The operation takes about an hour under local anesthesia with IV sedation.
After surgery, there is some stitch outside to fix the transposed fat and compression tape is applied to lower eyelid to minimize swelling and bruise.
Not only women but also men undergo lower eyelid surgery a lot by this method.

1 year after transconjunctival fat transfer.
Lower eyelid fat bulging, dark circle, tear trough deformity are corrected successfully.

Transconjunctival fat transfer is the ideal method for correction of dark circle.
8 months after

After 2 years of transconjunctival fat transfer

Minor deformity in lower eyelid can be fixed with fat graft.
Fat is taken from belly or thigh and injected under tear trough.
Disadvantage of this fat graft is frequent irregularity and fat absorption.
Fat from fat graft and fat from fat transposition are totally different.
Because the fat in fat transposition maintain blood supply, the fat survives nearly 100 %.
But fat in fat graft is absorbed about 40 %.
To prevent irregularity, fat should be grafted conservatively in deep layer only.

Filler injection can replace lower eyelid fat graft.
Healing is faster (immediately) and can be repeated more easily.

Because he has little fat in lower and upper eyelids, fat was grafted on both eyelids.
10 months after fat graft.

So, transconjunctival fat transfer is the best method of lower blepharoplasty in most of cases.

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Hyuncheol Park MD


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