Transconjunctival fat repositioning blepharoplasty: is excess fat herniation a prerequisite?

Background: The fat repositioning technique has been widely used for the treatment of tear trough deformity, and there is a strong belief that excess fat herniation is a prerequisite for the procedure. Objective: The purpose of this study was to evaluate its effect in patients with minimal or no excess fat herniation. Methods: A total of 232 patients underwent the procedure and met the inclusion criteria. Of them, 198 were primary cases, and 34 had a history of fat removal for blepharoplasty. The amount of infraorbital fat was evaluated preoperatively by palpation. Release of the tear trough ligament and fat redistribution were sequentially performed as previously described. Surgical outcome was assessed based on Hirmand’s grading system and the FACE-Q scales. Results: Tear trough deformities were eliminated in more than 85% of cases. Aesthetic results were comparable between the primary and secondary surgery groups. The percentage of patients who complained of extremely or moderately severe tear trough deformities decreased from 86.3% preoperatively to 34.0% postoperatively. The scores of the lower eyelid FACE-Q decreased significantly (P<0.05). Patients were satisfied with their decision to undergo blepharoplasty (78.2±18.7). Undercorrection of the tear trough occurred in 30 patients. Other complications included 12 cases of transient conjunctiva bleeding, 2 cases of eyelid numbness, and 6 cases of dry eye. These resolved spontaneously. Conclusion: Fat repositioning is a feasible and effective technique for the treatment of tear trough deformities in patients with minimal or no excess orbital fat herniation provided that a fat pad is palpable. Level of Evidence: 4