Addition of "Septal Window" to Lower Blepharoplasty for the Management of Fat of the Lower Eyelids
Mokhtar Asaadi1, Margaret Luthringer2, Laura Reed3, Bao Ngoc N. Tran2
1Plastic and Reconstructive Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA, 2Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA, 3University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
Background: Traditional lower blepharoplasty involves the excision of skin, muscle, and fat via either a subciliary or transconjunctival approach. Direct fat excision, septal reset, fat grafting, or a combination of these elements can be used to soften the nasojugal groove and lid/cheek junction, and to add bulk to hollow under eyes. The techniques employed depend on preoperative assessment and surgeon’s preference. We propose the management of post-septal infraorbital fat through a septal window—a small septotomy on the lateral fat compartment from which excess fat can be removed before septal reset and excision or transposition of fat to correct nasojugal grooves and lid/cheek junction.
Methods: We reviewed relevant anatomy of the lower eyelids, preoperative assessment, and surgical approaches. Our lower blepharoplasty includes canthopexy, Kenalog infusion under the musculocutaneous flap laterally, orbicularis muscle suspension, and conservative excision of the lateral skin. Retrospective review of all lower blepharoplasties done by a single surgeon in the past 12 years was performed. Surgical details and common postoperative morbidities were analyzed.
Results: Of the 224 patients, only two patients required additional fat excision or grafting to correct nasojugal groove and lid/cheek junction. The most common postoperative morbidities were eyelid edema, malar edema, and chemosis, all of which were self-limiting. There were no incidences of lid margin eversion, diplopia, changes in vision, loss of vision, sensory deficit, hyperesthesia, facial motor weakness, hypertrophic scarring, or permanent change in shape of the eyes. Resumption of full activities and exercises at 12 weeks was typical.
Conclusion: The septal window technique described here allows for easy access to the lateral fat pad for removal. It affords the surgeon the opportunity to make precise refinements of the post-septal infraorbital fat pads after septal reset. This technique has yet to be described in the literature. It is a simple maneuver to adjust lower lid volume, obviating the need for autologous fat grafting.
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