The sliding fat pad technique with use of the transconjunctival approach

The different possibilities for management of excessive or pseudoherniated fatty tissues in the lower eyelid are a subject of lively discussion in the field of aesthetic surgery.

We present a technique that uses the transconjunctival approach for the simultaneous treatment of excessive or pseudoherniated fat and marked periorbital sulci, which is based on the sliding fat pad technique first described by Loeb.

Incision of the conjunctiva, inferior tarsal muscle, and capsulopalpebral fascia is performed about 3 mm above the fornix. Dissection is performed following the preseptal-suborbicularis dissection plane, freeing the arcus marginalis, traversing the malar septum, and passing below the palpebromalar and nasojugal sulci. Retraction is performed with a specially designed transconjunctival retractor and lower-lid retractor. The orbital septum is opened and blunt dissection of the inner and central fat bags is performed. The fat flap is secured with transcutaneous stitches tied over small pieces of silicone. A transcutaneous-transconjunctival suture is performed to reduce postoperative discomfort and promote scarring of the transected planes.

We have achieved aesthetically satisfactory results with no major complications.

The sliding fat pad technique by the transconjunctival approach is a new technique that allows a natural and effective simultaneous correction of the lower eyelid, periorbital sulci, and mild cutaneous excesses with no disruption of the muscular and cutaneous planes, prompt recuperation, and a very low incidence of adverse effects when performed by surgeons experienced in transconjunctival procedures. (Aesthetic Surg J 2001;21:487-492.).