Effectiveness of Transconjunctival Fat Removal and Resected Fat Grafting for Lower Eye Bag and Tear Trough Deformity.

Importance: The main treatment of lower eye bags is changing from fat removal techniques to fat repositioning techniques. However, fat repositioning techniques have potential complications because of disruption of the middle lamellae, leading to contracture and shortening.

Objective: To determine whether transconjunctival fat removal followed by resected fat grafting is an effective alternative method of eye bag treatment.

Design, setting, and participants: This retrospective study of 229 consecutive patients who underwent transconjunctival fat removal followed by resected fat grafting from November 1, 2011, to October 31, 2017, was conducted by review of medical records from the Seoul H Dermatology Clinic in Seoul, Korea.

Main outcomes and measures: Comparison of patient satisfaction and modified Goldberg scores before and after surgery.

Results: A total of 229 patients (mean [SD] age, 41.24 [11.11] years; range, 20-69 years; 164 [71.6%] female) underwent transconjunctival fat removal followed by resected fat grafting. Of the 229 patients, 224 (97.8%) were satisfied with their surgical results, and major improvements were seen in the mean (SD) preoperative and postoperative scores for orbital fat prolapse (preoperative: 1.94 [0.63]; postoperative: 0.07 [0.21]), tear trough depression (preoperative: 1.61 [0.75]; postoperative: 0.33 [0.42]), skin transparency (preoperative: 1.15 [0.97]: postoperative: 0.22 [0.37]), and triangular malar mound (preoperative: 0.37 [0.61]; postoperative: 0.34 [0.58]). Although the orbicularis prominence worsened after surgery, this outcome should be interpreted as a good result for Asian patients. Skin elasticity deteriorated postoperatively.

Conclusions and relevance: The findings suggest that transconjunctival fat removal followed by resected fat grafting is an effective and safe technique to treat lower eyelid fat herniation without increased complication rates and provides good patient and surgeon satisfaction.

Level of evidence: 4.