Transconjunctival orbital fat repositioning: Transposition of orbital fat pedicles into a subperiosteal pocket

Rejuvenation of the lower eyelid complex is based on the principle that the contour changes characterizing aging involve not only prolapse of orbital fat but also descent of the cheek tissues, resulting in accentuation of the orbital rim and tear trough groove. When a deep groove is present along th e orbital rim in the area of the tear trough deformity, it is advantageous, rather than removing orbital fat, to reposition the fat over the orbital r im through the opened arcus marginalis onto the superior face of the maxill a. Orbital fat repositioning can be accomplished through a transconjunctival a pproach. The arcus marginalis is exposed and incised, and a subperiosteal p ocket is created over the superior face of the maxilla. The subperiosteal p ocket shape and location are customized based on the desired location of th e orbital fat pedicle; often the origins of the levator superioris labialis and the levator alae nasi muscles are partially dissected. Medial and cent ral fat pedicles are created and rotated over the orbital rim into the subp eriosteal pocket. A 6-0 polypropylene externalized sutured is used to fixat e the fat pedicle in position. The suture can be removed after 3 to 5 days. Twenty-four patients were followed clinically after orbital fat repositioni ng, with followup ranging from 6 to 30 months.,Although the fat pedicle und ergoes some variable resorption, the viability of the graft, the texture an d contour of die repositioned fat after a healing period of 1 to 2 months, and the excellent patient acceptance are indicative of the viability of orb ital fat repositioning.