Blepharoplasty Miller TR Private Practice Refreshed Aesthetic Surgery Aliso Viejo CA Introduction Pseudofat herniation in the lower eyelid area is a common reason l ower eyelid blepharoplasty is ID: 928436
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Slide1
Long Term 3D Volume Assessment after Fat Repositioning Lower Blepharoplasty
Miller TR.
Private Practice,
Refreshed Aesthetic Surgery,
Aliso Viejo, CA.
Slide2IntroductionPseudo-fat herniation in the lower eyelid area is
a common reason
l
ower
eyelid blepharoplasty is
performed
.
Surgical
techniques that are commonly used to correct pseudo-fat herniation can typically be categorized as fat
preservation
or fat
subtractive.
Fat
repositioning lower blepharoplasty is a fat
preservation technique
that offers distinct advantages, namely effacing the tear trough by releasing the tethering orbicularis retaining ligament with the subsequent addition of volume to the tear trough and upper malar
area.
Slide3Purpose
The purpose of this study was to determine the long term volumetric effects that the lower blepharoplasty fat repositioning technique provides
to the tear trough and deep fat compartments of the
periorbital area and upper
cheek
.
Slide4Relevance to Clinical Practice
Pseudo-fat herniation in the lower eyelid area is
a common reason for lower blepharoplasty because
the condition can impart an unwanted tired or sad appearance
.
Fat repositioning lower
blepharoplasty
offers distinct advantages, especially when recognizing the interrelationship between periorbital aging
and periorbital and
midface anatomy.
The fat repositioning
technique
involves the use of
vascularized
pedicles of orbital fat and
re-positions
these
fat
pedicles
within the
adjacent
prezygomatic
and
premaxillary
spaces, which has been theorized to offer the best
plane and areas
for augmenting and rejuvenating the periorbital and malar areas
.
Techniques based on removing orbital fat
do
not provide
this
benefit.
Slide5Description of Evidence
A retrospective electronic medical record chart review was performed to identify patients who underwent
only primary
lower blepharoplasty with fat repositioning.
Three-dimensional
(3D) images
were taken of patients the day of surgery and at least 10 months post-operation
(range 10-16 months
).
The area selected for volume analysis was based on the areas typically affected by fat
repositioning lower blepharoplasty.
The area selected
on the before 3D image was
then identically duplicated on the patient’s 3D post-operative
image
and
calculations
of volume
differences were performed. The
average volume gain
in the area of study was
0.64
cc.
Slide6Description of Evidence
Three-dimensional
colorimetric
analysis. Blue
color representing increased
volume at 12 months post-operation.
Three-dimensional
untextured
image.
12 months after fat repositioning. Results illustrates long term volume augmentation of tear trough and anterior cheek.
Before
After
Slide7Description of Evidence
Same patient in previous slide
12
months after fat
repositioning.
Before (
top left
) and 12 month post-operative result (
top right
). Black line outlining and emphasizing contour change, before (
bottom left
) and after (
bottom right
).
Slide8Controversies and ConsensusRecent cadaveric studies have shown the face is divided into several discrete superficial and deep fat compartments. Changes in these fat compartments are responsible for many of the differences observed when comparing the aging and youthful face.
The
deep fat compartments of the periorbital and
upper midface areas consists of
the deep medial fat, and the medial and lateral sub-orbicularis orbital fat (SOOF
) compartments.
Surgical techniques that are commonly used to correct pseudo-fat herniation of the lower eyelids can typically be categorized as fat preservation or fat subtractive. The fat repositioning lower blepharoplasty is a fat preservation technique.
Slide9Controversies and Consensus
Fat repositioning lower blepharoplasty is a surgical technique that reduces the prominence of the lower eyelid fat pads (pseudo-fat herniation), while simultaneously effacing the tear trough and providing supplemental volume augmentation to the fat compartments of periorbital and upper cheek areas: the deep medial fat and medial and lateral SOOF compartments.
Fat subtractive techniques may address pseudo-fat herniation by removing fatty tissue, but these techniques do not address the other signs of periorbital and midface aging (e.g., direct improvement, or “leveling” of the tear trough and volume augmentation of the deep fat compartments).
Slide10Controversies and Consensus
Three-dimensional (3D) imaging is increasing in popularity in plastic surgery and use in scientific studies.
Comparing three-dimensional
(3D)
images (i.e., before and after images) entails many steps including patient positioning, registering of landmarks, and computer
mathematical models and
calculations.
As
a result, each step has the potential for measurement errors that may be further reduced with future advancements in the expanding field of 3D imaging and analysis.
Slide11Comment
T
he
fat repositioning technique requires a more thorough grasp of anatomic knowledge, surgical proficiency and operating
time; however, the
results have been shown in the current study to be aesthetically beneficial and the results long
lasting.
How the increased volume after fat repositioning mathematically
compares
to the volume of injected free fat grafts or a hyaluronic acid filler is difficult to determine
.
T
he
volume expansion by filler or fat transfer may not exhibit a 1:1 correlation to repositioned
fat during lower blepharoplasty. Further studies are required.
Slide12CommentD
ifferent techniques have been described for the fat repositioning lower blepharoplasty.
Specifically, the
author uses a subperiosteal
plane
but transitions from this plane at the level of the
levator
labii
superioris
muscle
. Other surgeons may use a supra-periosteal plane.
Recent studies
(not using 3D imaging) have shown no significant differences in aesthetic outcomes based on planes of dissection during fat repositioning lower blepharoplasty.
Future studies need to be performed, using 3D imaging analysis, to evaluate the volumetric effects when different planes of dissection are used.
Slide13ConclusionsThe lower blepharoplasty fat repositioning technique is
an effective
procedure for improving
lower eyelid pseudo-fat herniation, while simultaneously improving the aging effects often seen in the periorbital and upper cheek areas.
The aesthetic improvement is explained by the release of ligaments
and
direct volume
augmentation of specific areas that have recently been defined by recent anatomical studies.
Slide14Contact Information
If you have questions, please contact the corresponding author:
Timothy R. Miller, M.D.
Refreshed Aesthetic Surgery,
2 Journey, Suite 208, Aliso Viejo, CA. 92656
e-mail:
drtimothymiller@gmail.com