A Board Certified Plastic Surgeon in Scottsdale
Eyelid Surgery
Facial Plastic Surgery: The Nasojugal Groove
02 years ago
Deep nasojugal grooves and fat grafting.
Scottsdale – In reporting this plastic surgery technique, I see a variation on the use fat grafting. As the authors explain, the technique is not truly new, but has been used before using a variety of other materials. In this article, the researchers placed a rolled fat graft into the nasojugal groove, one of the most challenging areas of the anatomy to obtain satisfactory correction.
The plastic surgeons in this study, obtained the fat graft from the fat pad found in the upper eyelid, which is typically removed during an upper eyelid lift or blepharoplasty. They then rolled the fat graft into the best shape to fill in the groove between the cheek and the eyelid, the nasojugal groove. Their technique offers two important advancements: the first is the choice of filler material. The fat of the eyelids is quite unique and many practitioners believe there is an advantage to using orbital fat when the need is in the human orbit. Second, the technique used to place the fat graft. They advocate creating a tunnel under the orbicular muscle. The tunnel is directly created by the surgeon using scissors. It is the combination of material and technique that adds up to establishing very nice results from this cosmetic surgery procedure. The before and after photos are truly impressive.
The article was published in the Aesthetic Surgery Journal in 2009, and was presented at the annual meeting of the American Society for Aesthetic Plastic Surgery in New Orleans, LA in 2005.
The authors make some important distinctions about when this type of plastic surgery should be used. It is indicated in patients in which there is no excessive fat found in the lower eyelids before surgery. The authors advocate a more traditional treatment to the groove and eyelid if the lower eyelid fat pads are present. That second cosmetic surgery procedure is a lower eyelid lift or blepharoplasty. The fat that is found in the orbit is placed into the groove using a sliding fat flap technique. Some plastic surgeons recommend other treatments for the groove including facial silicone implants like the Flowers Tear Trough implant.
My view on Plastic Surgery.
My take on this cosmetic eyelid surgery technique: I found this article and technique very useful. The fact that you can custom design the fat graft to fit the patient’s groove is quite important. This allows the plastic surgeon to treat more variations of the same deformity in more patients. Fat is an ideal material and can be universally applied using this technique. The other useful aspect of the technique offered was the use of the pocket under the orbicualris muscle. This is an important step because grafts placed above the muscle and under the thin eyelid skin can be seen when the swelling dissipates after surgery. By going below the muscle, the cosmetic surgeon can feel more confident about the post-surgery results being smoother and avoiding step-offs and lumpiness in the eyelids.
In fact, I use the same dissection technique, under the orbicularis muscle, and place the fascia of the postauricular muscles in the nasojugal groove.
This is a very effective technique in my practice. I have been using this method since I published the anatomy and harvest techniques for the postauricular fascia in the journal Archives of Facial Plastic Surgery in 2004.
TUB: 7 years later – still a good technique.
02 years ago
by Dr. Aldo
in Eyelid Surgery
Scottsdale – Some seven years ago, when I was faculty in the plastic surgery section at the Louisiana State University Health Sciences Center, I published an article on cosmetic eyelid surgery in the Annals of Plastic Surgery. We called the surgery the TUB technique. The article featured a transconjunctival approach for the removal of excess fat in upper eyelid rejuvenation. I continue to use this technique even after all this time with good success.
The transconjunctival upper blepharoplasty was a relatively new technique at the time. It is still used today by the authors of the article, including myself. I reserve the procedure who have had blepharoplasty and still retain some fat tissue in the upper eyelid. Many of these patients do not want their surgeon to open up the healed eyelid incision. This operation offers a pathway to the fat pad from the inside – via the conjunctiva of the upper eyelid, avoiding re-operation on the external scar. It is a safe and reliable technique.
A gentle laser or chemical peel can be performed to tighten the skin during the TUB technique. This procedure continues to be an effective method of removing medial upper eyelid fat with minimal risks.
When is the right time for Eyelid Surgery?
02 years ago
Scottsdale – There is no age requirement for eyelid rejuvenation surgery. Once you notice some dissatisfaction with your eyelids, it may be time to seek a consultation with a board certified plastic surgeon. Any one or combination of the following conditions may indicate that you are a good candidate for eyelid surgery:
- Excess skin obscuring the natural fold of the upper eyelids.
- Loose skin hanging down from the upper eyelids, perhaps impairing vision.
- A puffy appearance to the upper eyelids, making the eyes look tired.
- Excess skin and fine, crinkly wrinkles of the lower eyelids.
- Puffy bags and dark circles under the eyes.
- Droopiness of the lower eyelids, showing white below the iris, the round-eye look.
For more information on eyelid surgery check out our website at www.MyFaceAndBody.com
Caution: Fat Grafting to Lower Eyelids, why I don't do it.
02 years ago
Scottsdale – Fat grafting is a popular procedure for rejuvenation of the face and contour improvement in the face and body. I have used fat grafting for the past 8 years to compliment my facelift technique and for body contour improvement. I recommend fat grafting for many conditions except in breast augmentation and eyelid rejuvenation.
A recent article in Aesthetic Plastic Surgery reviews the potential complications which can result from fat grafting to the lower eyelids. The study presents a single case where a patient received fat grafting to the lower eyelids 5 years before consulting with the senior author of the article. The patient had the initial procedure in Germany and experienced a deformity of the eyelids at the time. According to the patient, she had a second fat graft procedure in an attempt to correct the deformity created by the first procedure. The result was worse and as time passed the patient became increasingly dissatisfied with the appearance of her eyelids.
The patient presented for correction and a surgical lower blepharoplasty approach was used. The fat graft was viable after 5 years and was located in a non-anatomical location between the skin and the orbicular muscle. Interestingly, there was no need to remove any orbicular fat. All the fat graft was successfully removed. The total volume of fat graft removed was 1.2 cc from the right and 1.8 cc from the left eyelid.
This case illustrates a couple of important facts about fat grafting. First, fat grafting like all other plastic surgery procedures can be associated with complications and may even require re-operation to obtain a better outcome. Second, fat grafts are more likely to be problematic when the fat is placed superficially where it is more likely to create contour deformity as shown in this case. In the eyelid, because it is so anatomically thin, the margin for error is very low, as there is a good chance some of the fat graft could end up in a shallow location. There are very good surgeons who can avoid this complication, but I have seen this exact complication in many patients even in the hands of experienced clinicians. For eyelids, I believe that standard blepharoplasty techniques are more predictable than fat grafting.
I am a proponent of fat grafting when I can place it deeply. Fat grafting can be performed safely and can be successful in achieving aesthetic goals. When I perform fat grafting to the face, for instance, I use a low pressure injection technique with very small volume placed per injection. The article points out that inappropriate injection technique has likely contributed to the very serious complications of fat grafting previously reported by other authors.
