Transconjunctival septal suture repair for lower lid blepharoplasty.

Background: The need for a safer lower-lid blepharoplasty procedure than the classic subciliary approach has long been recognized. In 1996, de la Plaza and de la Cruz first theorized septal suturing via a transconjunctival approach that preserves both muscle and infraorbital fat. This is the first report of a series of patients treated with this technique. The transconjunctival approach can avoid the complications of "scleral show" and changes in the shape of the aperture that are associated with the subciliary/muscle cutting approach to the fat pads. Methods: Transconjunctival septal suturing of the middle and medial fat bags was used to treat 78 consecutive patients (72 women and six men) with visible bulging fat of the lower eyelids. Some patients underwent simultaneous resection of fat from the lateral pad. Results: Bulging fat in the middle and medial compartments was eliminated without overtreatment or undertreatment. Substantial but not total improvement in tear trough deformity was often observed. Aperture shape and lid level were preserved. Conclusions: The results achieved with this series of patients indicate that transconjunctival suture repair of the orbital septum is a safe, predictable, and effective treatment for bulging fat of the medial and middle fat pads of the lower eyelid. Changes in aperture shape and lid level can be avoided without the need for simultaneous lid-tightening procedures.