LOWER BLEPHAROPLASTY WITH FAT REPOSITIONING Sarina Rajbhandari Fellow

LOWER BLEPHAROPLASTY WITH FAT REPOSITIONING - Sarina Rajbhandari Fellow Department of Otolaryngology, Head & Neck Surgery Tri Service General Hospital -Chuan- Hsiang Kao 希望美醫診所; 晶華美醫診所三總耳鼻喉頭頸外科部醫美中心 Dr Kao Hope Aesthetic Clinic; La Mer Aesthetic Surgical Clinic Cosmetic and Laser Center, Dept. of Otolaryngology-Head and Neck Surgery Tri-Service General Hospital www. drkaobeauty. com

• Facial plastic surgery is an emerging subspeciality in ENT. • Focuses on improving patient’s facial appearance. • Eyelid rejuvenation -Upper-lid blepharoplasty, ptosis repair - Transconjunctival lower-lid blepharoplasty (with or without skin pinch) -Transcutaneous skin-muscle flap (with or without midfacial extension

THE BEAUTIFUL EYE • Brow – centrally on rim, laterally above the rim • Upper lid crease <10 mm above lid margin • Lateral lid free of hooding

The Aging Face - Descent of lower lid - Descent of malar fat pad - Increase in size of tear trough - Nasolabial folds

FAT POCKETS Medial fat pad Central fat pad

Goals of Lower blepharoplasty with Fat Reposition (LBP with FR) • To create a smooth transition from the lower lid to the cheek • To get more natural, youthful look without abnormal hollowness • To avoid complications • Now blepharoplasty has moved from removal to repositioning the fat

DATA • • • March 2015 – August 2018 Total number of cases: 59 F: M = 52 : 7 Maxium age = 68 years Minimum age = 20 years Mean age = 35 years

Preoperative Evaluation

Lower Blepharoplasty with Fat Reposition (LBP+FR) • Transcutaneou s approach - External approach with subcillary incision - Skin pinch/Skin -muscle flap excision

Lower Blepharoplasty with Fat Reposition (LBP+FR) • Transconjunctiv al approach - Fat transposition, fat grafting - SOOF, malar fat pad

Good Candidates for TCLBP Poor Candidates for TCLBP • Young-middle aged patients • Mild to moderate drooping of periorbital tissue • No apparent redundant lower lid skin • Patients with reasonable expectation • Elder patients • Severe drooping of periorbital tissue or face • Apparent redundant lower lid skin need to be excised • Patients with overexpectation

Surgical Procedure

Preoperative Postoperative

RESULTS -Out of 59 patients, 50 patients underwent transconjunctival and 9 patients underwent transcutaneous lower lid blepharoplasty. -Only one person required revision LLB. (Right eye, due to residual eye bag) -None of the cases experienced complications.

COMPLICATIONS -Hematoma -Scarring -Persistent oedema - Diplopia -Ocular Injury -Round eye ( Inferior retraction of the lower lid, scleral show and rounding of the lateral canthus) -Ectropion -Loss of vision -Chemosis -Over or under correction

CONCLUSION • LBP with fat repositioning can have natural results • Less complications • Adjunctive procedures might be required for more favorable results

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