Orbicularis Paresis After Fat Transposition for Tear Trough Deformity

Area of Science:

• Ophthalmology
• Plastic Surgery
• Facial Anatomy

Background:

• Tear trough deformity is commonly managed with orbital fat transposition.
• This procedure involves repositioning orbital fat to improve the lid-cheek junction.
• Lower blepharoplasty is a frequent surgical intervention for aesthetic concerns around the eyes.

Purpose of the Study:

• To report cases of orbicularis paresis following lower blepharoplasty with supraperiosteal fat transposition.
• To investigate the potential cause of orbicularis paresis in relation to surgical technique.
• To propose an alternative surgical approach to mitigate this complication.

Main Methods:

• Case report of two patients experiencing unilateral orbicularis paresis post-procedure.
• Postoperative video analysis to quantify blink amplitude reduction.
• Histological consideration of motor nerve fiber course in the lower eyelid.

Main Results:

• Patients exhibited markedly reduced blink amplitude in the affected eye two weeks postoperatively.
• Blink amplitude normalized, and ocular exposure symptoms resolved by six months.
• The sub- and intramuscular course of orbicularis oculi motor nerves in the medial lower eyelid was identified as a vulnerable area.

Conclusions:

• Supraperiosteal orbital fat transposition carries a risk of injuring motor nerves to the orbicularis oculi muscle, leading to paresis.
• A subperiosteal approach to orbital fat transposition may help avoid damage to these critical nerves.
• This approach could potentially prevent postoperative orbicularis paresis and associated complications.