The tear "TROUF" procedure: transconjunctival repositioning of orbital unipedicled fat

Aging of the lower lid and cheek results in bulging of orbital fat and deepening of the orbital rim groove, known as the "tear trough." As an alternative to orbital fat excision, pedicles of fat can be spread in a submuscular plane to obliterate the groove of the tear trough. In a 1-year period, 25 patients had correction of their tear trough deformities through a transconjunctival approach. This technique included incision of the septum near the arcus marginalis, dissection of a suborbicularis pocket, and placement of medial and central fat pedicles over the orbital rim with buried 5-0 plain gut sutures. Clinically, after a follow-up of 17 to 31 months, there was leveling of the tear trough, smooth contour of the lower lid and cheek, minimal complications, and high patient satisfaction.