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LOWER BLEPHAROPLASTY WITH FAT REPOSITIONING

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

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LOWER BLEPHAROPLASTY WITH FAT REPOSITIONING

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  1. LOWER BLEPHAROPLASTY WITH FAT REPOSITIONING - SarinaRajbhandari 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

  2. Facial plastic surgery is an emerging subspeciality in ENT. • Focuses on improving patient’s facial appearance. • Eyelid rejuvenation • Upper-lid blepharoplasty, ptosis repair - Transconjunctivallower-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 - Nasolabialfolds

  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

  13. Preoperative Postoperative

  14. Preoperative Postoperative

  15. Preoperative Postoperative

  16. 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.

  17. 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

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

  19. THANK YOU

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