Transconjunctival Fat Repositioning Using Barbed Sutures

Transconjunctival orbital fat repositioning is a surgical technique that resolves protruding orbital fat and sunken tear troughs through a single procedure. The procedure involves incision of the conjunctiva and dissection of the tear trough and orbicularis retaining ligaments, followed by repositioning of the sufficiently released orbital fat as a pedicle. Various techniques have been used to fixate the repositioned fat, including direct suturing of the fat to the target area (internal fixation) and suturing the repositioned fat pedicle and pulling out the suture toward the lower eyelid skin (external fixation). There are technical challenges attributable to both techniques, including a narrow operative field of view (internal fixation) and a high likelihood of relapse because the fat is not sutured directly to the tear trough area (external fixation). To overcome these disadvantages, the authors present a novel technique comprising barbed sutures.