Dermal Onlay Grafts: A Rescue Procedure for Secondary Inferior Periorbital Hollows.

BACKGROUND Various procedures to efface age-related lower eyelid/cheek interface depressions, or primary periorbital hollows (POHs), have been reported in the literature. Post-surgical, or secondary POHs, are a distinct contour irregularity that has received little such attention. The authors have implanted autologous dermis fat grafts (DFGs), or what they call dermal onlay grafts (DOGs), for secondary POHs which fail less invasive measures. Herein the authors experience with these recalcitrant cases of secondary POHs is presented. OBJECTIVES To describe the surgical technique and outcomes of DOGs for secondary POHs. METHODS A retrospective analysis of patients who underwent DOGs for secondary POHs over a 27-month period was performed. The surgical technique and outcomes are reviewed. RESULTS Thirteen patients (10 women and 3 men; average age, 52 years; and average follow-up, 9 months) are included in the study. Nine patients had bilateral surgery, and all had previous filler or fat injection, or both, with poor outcomes. Generally, surgical complications were minor, required minimal intervention or were self-limiting. One patient had persistent infraorbital dysesthesia which improved significantly with oral tricyclic antidepressant treatment. Eleven of 13 patients stated satisfaction with hollow effacement and outcome, which was similarly verified by surgeon subjective assessment. CONCLUSIONS DOGs yielded good results in this initial description of their utility as a rescue procedure to surgically address secondary POHs. Further quantitative volumetric studies to validate outcome would of value.