Endoscopic Retro-Orbicularis Oculi Fat Transposition for Correction of Sunken Eyelid Deformity

The periorbital area is susceptible to aging and structural changes, resulting in sunken eyelid deformities characterized by a hollow upper eyelid and pronounced orbital bone prominence. Conventional treatments, such as dermal fillers and fat grafting, have limitations in providing consistent and lasting results.This retrospective study introduces the endoscopic Retro-Orbicularis Oculi Fat (ROOF) transposition technique as a novel approach to correct sunken eyelid deformities and enhance lateral orbital convexity.

Twenty-six patients (25 female, 1 male; mean age: 34, range: 24-44) with noticeable supraorbital rim prominence and no excess upper eyelid tissue underwent endoscopic ROOF transposition between January 2021 and January 2024 were included. The procedure was performed through minimal scalp incisions with endoscopic visualization. Twenty-four patients also had concurrent endoscopic midface and temporal lift procedures, while two underwent forehead lift. Preoperative and postoperative images were evaluated at the 12-month follow-up.

Postoperative assessments demonstrated significant improvements in eyelid contour and lateral orbital fullness, with stable results throughout the follow-up period. Early postoperative edema and bruising resolved within one week. No irregularities or complications were reported, and patient satisfaction ranged from good to excellent.

The endoscopic ROOF transposition technique provides a minimally invasive and effective solution for sunken eyelid deformities, offering lasting results without donor site morbidity. This approach can be combined with other endoscopic facial rejuvenation procedures, though the technique requires expertise and does not fully address medial orbital deformities.

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