Micro Free Orbital Fat Grafts to the Tear Trough Deformity during Lower Blepharoplasty

BACKGROUND:The tear trough deformity is challenging in lower eyelid rejuvenation. Surgical treatment has evolved with more modern techniques preserving orbital fat and using autologous fat transposition. The author reviewed his own experience in targeting the tear trough in lower lid blepharoplasty and presented a new technique that incorporates the addition of micro free fat grafts which adds direct volume to the underlying anatomical depression using a transcutaneous skin-muscle approach. METHODS:Medical records of lower lid blepharoplasty patients performed from February of 2011 and February of 2016 were reviewed. Patients who had tear trough deformities with the addition of micro free fat grafts were included. Standard patient characteristics were collected, complications identified, and assessment of postoperative results were performed. RESULTS:There were 32 patients included in the study with a median follow-up of 392 days (range 45 to 1709 days). Scleral show requiring operative correction occurred in one patient (3 percent). Additional complications included chemosis in 4 patients (13 percent) which resolved in all patients. No patients had infections, ectropion, lid retraction, palpable or visible grafts. CONCLUSIONS:The use of micro free orbital fat grafts is an effective and safe technique to treat the tear trough deformity without increased complication rates and good patient and surgeon satisfaction and should be considered a surgical adjunct during an open blepharoplasty technique.