1. 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

2. 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

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

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

5. FAT POCKETS
Medial fat pad
Central fat pad

6. 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

7. 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

8. Preoperative Evaluation

9. Lower Blepharoplasty with Fat Reposition (LBP+FR)
Transcutaneous approach
- External approach with subcillary incision
- Skin pinch/Skin-muscle flap excision

10. Lower Blepharoplasty with Fat Reposition (LBP+FR)
Transconjunctival approach
- Fat transposition, fat grafting
- SOOF, malar fat pad

11. 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 over-expectation

12. Surgical Procedure

14. Preoperative Postoperative

15. Preoperative Postoperative

16. Preoperative Postoperative

17. 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.

18. 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

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

20. THANK YOU