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Published on: December 5, 2025
Improving Midcheek Deficiency and Tear Trough Deformity Using a Hammer-Shaped Orbital Fat Transposition: A
Background:
Tear trough deformity and midcheek flatness frequently coexist, particularly in East Asian patients. Conventional orbital fat repositioning techniques often provide limited midcheek projection and may be technically demanding through a transconjunctival approach.
Objectives:
The authors describe and evaluate a modified technique combining hammer-shaped orbital fat reconstruction with Z-shaped semi-fixation to simultaneously correct tear trough deformity and midcheek deficiency.
Methods:
A retrospective case series of 523 consecutive patients undergoing transconjunctival lower blepharoplasty using this technique was performed. Clinical outcomes were assessed using the Barton grading system and patient-reported satisfaction, with a mean follow-up of 8.5 months.
Results:
All patients demonstrated improvement of at least 1 Barton grade postoperatively. Overall aesthetic satisfaction was rated as good by 89.1% of patients. Complications were uncommon and self-limited, with no cases of lower eyelid malposition or scleral show.
Conclusions:
In this retrospective series, hammer-shaped orbital fat repositioning with Z-shaped semi-fixation was associated with improvement in tear trough severity and patient-reported aesthetic satisfaction, with a low short-term complication rate. This approach may represent a practical option for selected patients with tear trough deformity and midcheek deficiency, although objective volumetric assessment and longer-term comparative studies are needed.
