Transconjunctival Lower Blepharoplasty Using Midcheek Spaces for Orbital Fat Transposition (S.O.F.T.)

The subperiosteum, supraperiosteum, and intrasuborbicularis oculi fat have been used as planes of dissection for orbital fat transposition in transconjunctival lower blepharoplasty. The steep learning curve due to the anatomic complexity in using any of the 3 planes may deter plastic surgeons from performing the procedure. We present the use of clear anatomical midcheek spaces, the premaxillary and prezygomatic spaces, as the plane for orbital fat transposition in transconjunctival lower blepharoplasty.We performed a retrospective study of 184 consecutive patients who underwent transconjunctival orbital fat transposition using the midcheek spaces from November 2013 to July 2019. Recorded data included the patient's age, duration of surgery, postoperative complications (chemosis; bleeding; lower eyelid swelling; orbital and/or lower eyelid infection; eye misalignment on primary gaze; binocular diplopia; numbness involving the lower eyelid, cheek, and upper lip; orbicularis oculi paralysis, inferior scleral show, and lower eyelid ectropion), aesthetic result, and patient satisfaction.The mean age is 35.48 ± 6.66 years. Significant aesthetic improvement was achieved not only for herniated orbital fat and prominent lid-cheek junction but also for midcheek depression over an average follow-up of 22.41 ± 16.04 months. The patient satisfaction score (98.91%) was high. No major complications occurred. The mean operating time was 46.74 ± 6.67 minutes.The natural midcheek spaces could be used as an ideal plane for orbital fat transposition in transconjunctival lower blepharoplasty. By using the midcheek spaces, transconjunctival orbital fat transposition can become a safe and effective technique without the steep learning curve.