ASOPRSFall Scientific SymposiumSyllabus
44
8:35 am
Questions andPanel Discussion
Moderator: EricA. Steele,MD
Panel: Charles Rice,MD, Eva Chou,MD, Bobby Korn,MD, JohnMartin,MD, Nambi Nallasamy,MD
VolumizationSession I
Moderator:Michael McCracken,MD
8:50 am
End-to-endFat PedicleRedraping for ImprovedContour of the Lower Eyelid
Mid-face Junction
MatthewSniegowski
1
, EvaChou
2
, VikramDurairaj
2
,MalenaAmato
2
, SeanBlaydon
2
, JohnShore
2
, Tanuj Nakra
2
.
1
Orbital Oncology and
OphthalmicPlasticSurgeryProgram, Department of PlasticSurgery, University of TexasMDAnderson, Houston, TX, UnitedStates,
2
TexasOculoplasticConsultants, Austin, TX, UnitedStates
Introduction:
The youthful mid-face has a smooth single convexity.With age, the firm attachments of the orbital retaining ligament
alongwith prolapse of orbital fat through a diaphanous orbital septum andmid-facial volume loss, can lead to lower eyelidmid-face
contour irregularitiesTraditional fat transposition,while improving the overall aesthetics of the eyelid-midface junction, can still lead
to peaks and valleys due to the discontinuity of the transposed fat.We propose the end to end fat pedicle transposition as a novel
technique to improve lower eyelid contour and overall aesthetics.
Methods:
A retrospective chart reviewwas performed on all consecutive patients undergoing lower eyelid blepharoplastywith
end to end fat pedicle transposition by the senior surgeon (TN), from January 2013 through February 2014.The technique involves
fixating the following: themedial aspect of themedial fat pad in themedial canthal subperiosteal pocket, the lateral aspect of the
medial fat pad to themedial aspect of the central fat pad deep into the subperiosteal maxillary pocket, and the lateral aspect of
the central fat pad to the deep lateral subperiosteal maxillary pocket.The pre and post-operative photoswere graded by three
oculoplastic surgeons on the overall aesthetic improvement aswell as the contour of the lower eyelid-midface junction. Postoperative
photoswere taken at least 3months after surgery.A set of patientswho had undergone standardmonofixation fat pedicle
transpositionwere included as control patients.
Results:
Therewere 22 patients included in the study; 14 patientswho underwent end-to-end lower eyelid fat pedicle transposition
and 8 patientswho underwent traditional fat transposition. Overall, therewas an aesthetic improvement in all patients undergoing
lower eyelid blepharoplasty, however, the group of patients undergoing the end to end transpositionwere judged to have had the
smoothest contour of the lower eyelid-midface junction.
Conclusions:
The end-to-end fat pedicle transposition lower blepharoplasty is safe and effective procedure to efface the tear trough
deformity in a smoothmanner in comparison to the traditional monofixated fat pedicle.
References:
Sullivan PK, Drolet BC. Extended lower lid blepharoplasty for eyelid andmidface rejuvenation. Plast Reconstr Surg.
2013Nov;132(5):1093-101.
Goldberg RA.Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr
Surg. 2000 Feb;105(2):743-8; discussion 749-51.
Haddock NT, Saadeh PB, Boutros S,Thorne CH.The tear trough and lid/cheek junction:Anatomy and implications for surgical
correction. Plast Reconstr Surg. 2009;123:1332-1340; discussion 1341.
Mendelson BC, Jacobson SR. Surgical anatomy of themidcheek: Facial layers, spaces, and themidcheek segments. Clin Plast Surg.
2008;35:395-404; discussion 393.
DetailedProgram
—Thursday,October 16, 2014
