Bringing the Patient Back to Social Life: The Use of Fat Grafting As An Adjuvant on Treatment for Lower Eyelid Retraction

Bringing the patient back to social life: The use of fat grafting as an adjuvant on treatment for lower eyelid retraction.

The authors have no Commercial Associations or Financial Disclosures

Goals/Purpose: Many surgeons largely accept the use of fat as a natural filler. The filling effect of fat has the potential to be used as a natural spacer, expanding areas with cicatricial retraction. Moreover, the anti-inflammatory properties of fat-derived stem cells are well recognized subsequent to the cell transfer to other areas. Eyelid retraction after blepharoplasty is a severe deformity that could potentially benefit from the anti-inflammatory and expansion effects of fat. We present a retrospective study of 16 patients who had fat injections in order to correct eyelid retraction following lower blepharoplasty.

Methods/Technique: All 16 patients presented eyelid retraction in the early postoperative period. The age range was between 42 and 62 years. In all patients, fat grafting was done within the first month of the original procedure under local anesthetic. The evaluation of lid laxity was done by gently pulling up the lower eyelid. Any patient with an eyelid margin transgressing the pupilar level was included in this study. Some patients were initially treated locally with steroid injections. In 10 patients where the eyelid retraction was the only objective of treatment, the fat was harvested and processed according to Coleman's principles. On the other 6 it was used the Puregraftš system. Patients that also requested facial fat transfer had the Puregraftš system as we could process more fat, quicker.  Around 0,5-1 cc of grafted fat was placed carefully in a deep plane; posterior to the orbicularis muscle, controlling at all times the placement and volume of fat given and also the position of the lower-lid margin.

Results/Complications: The new position of lower eyelid margin was evaluated by measuring the distance between the lower margin and iris and then comparing before and after photos. In all cases, successful elevation of the lower eyelid margin was achieved. Both processing systems provided fat that achieved the proposed objective. The average elevation was 1,2 mm. (Figure 1)

Conclusion: The fat-injection procedure is simple, quick, safe and effective in stabilizing and repositioning the lower eyelid. Originally, patients who have undergone blepharoplasty should wait 8-12 weeks for any surgical attempt of correction. This technique has minimal associated risks and complications and has been shown to be helpful in correcting mild lower lid retraction in the early postoperative period when no other surgical treatment is possible.

Figure 1: A) Patient 6 weeks post blepharoplasty with eyelid retraction. B) Same patient after one week of grafting of 0,3ml cc of fat.