Correction of severe enophthalmos by simultaneous fat grafting and anatomic orbital reconstruction

Secondary enophthalmos correction, especially in severe cases, represents a surgical challenge. The complex injury pattern involving the hard and soft tissue warrants individualized multimodality treatment strategies. Even with seemingly successfully surgical execution, relapse or incomplete correction of globe position can occur. In an attempt to improve ability for correction, we have implemented concurrent endo-orbital fat grafting and orbital framework reconstruction. The purpose of this study is to describe our treatment approach and objectively analyze the results.

Preoperative and postoperative clinical examinations, Hertel measurements, and radiologic imaging were recorded. Orbitometric measurements were performed using a three-dimensional postprocessing software (SurgiCase; Materialise, Leuven, Belgium). A follow-up period of at least 6 months was taken for final evaluation.

Postoperatively, all patients showed a significant improvement of the globe's position. Neither visual impairment nor disability of globe motility was seen. Hertel and three-dimensional orbitometric measurements showed significant (P < 0.05) globe projection improvement representing a mean of 4.2 and 3.7 mm. Orbital volume (25.65 mL) significantly decreased after surgery (22.98 mL).

Alloplastic orbital floor reconstruction in combination with endo-orbital fat grafting represents an excellent method to achieve adequate globe support and positioning even in secondary enophthalmos correction.