Complete Orbital Septum Release and Full Integration and Repositioning of Orbital Septal Fat Tissue (F.I.R.S.T.) in Transconjunctival Lower Blepharoplasty.

[BACKGROUND] After the introduction of orbital septal fat release and reposition in transconjunctival lower blepharoplasty (TCLB), few studies have addressed the thorough release of orbital fat tissue to adequately augment the tear trough and midface concavity. Additionally, limited literature exists regarding residual or recurrent eye bags and corresponding preventive measures after fat release and repositioning in TCLB.

[METHODS] From December of 2021 to May of 2023, 105 patients were treated with the full integration and repositioning of orbital septal fat tissue (F.I.R.S.T.) technique in TCLB. This study observed the effectiveness of correcting tear trough deformity (TTD) and midcheek depression using the technique, and we have documented all complications, especially the residual eye bags.

[RESULTS] This mean age was 34 years (range: 19-54 years) with a mean follow-up of 13 months (range: 3-17 months). The average operation duration was 55 ± 7.1 minutes (range: 45-89 mins). Among the cases, 70 eyes (33.33%) had Grade I TTD, 92 eyes (43.8%) had Grade II TTD, and 48 eyes (22.9%) had Grade III TTD. Successful correction was achieved in all Grade I cases, with 75 eyes (81.52%) improving to Grade 0 among Grade II cases. For Grade III cases, 28 eyes (58.33%) improved to Grade 0. Our technique has significantly improved the tear trough area for nearly 2 mm. Only one patient complained about fat residual and no patients had relapses.

[CONCLUSIONS] The F.I.R.S.T. technique effectively prevents fat residual in the lower eyelid area and provides favorable postoperative filling effects in the tear trough and midcheek region.

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