Retro-orbicularis oculi fat reduction via sub-brow incision in thyroid eye disease

The retro-orbicularis oculi fat (ROOF) hypertrophy contributes to upper eyelid fullness in patients with thyroid eye disease (TED). This report describes the surgical technique and evaluates the aesthetic and clinical outcomes of ROOF reduction via a sub-brow incision in patients with TED. This retrospective observational study included 60 patients (118 eyelids; 2 males and 58 females; mean age, 46.2 ± 13.2 years) who underwent ROOF excision between October 2019 and January 2025. Data collected included patient demographics, surgical details, ROOF thickness (measured by imaging studies), volume of excised fat, margin reflex distance-1 (MRD-1), and postoperative complications. Patient satisfaction was assessed at the 3-month follow-up. Consequently, the mean volume of ROOF excised was 0.69 ± 0.51 mL. Concurrent fat removal included excision of the preaponeurotic fat pad in 77 eyelids (mean volume excised: 0.59 ± 0.23 mL) and the medial fat pad in 45 eyelids (mean volume excised: 0.17 ± 0.10 mL). ROOF thickness correlated moderately with the volume excised (r = 0.395, p < 0.001). MRD-1 did not significantly change postoperatively (preoperative: 4.4 ± 1.1 mm; postoperative: 4.5 ± 1.0 mm; p = 0.626). A high patient satisfaction rate of 93.3% was achieved. No major complications were reported. This report indicates that ROOF excision via a sub-brow incision is a safe and effective adjunct to aesthetic eyelid surgery, offering improved cosmetic outcomes with a low complication rate. This technique may be considered in patients with TED presenting with prominent upper eyelid fullness.