Percutaneous External Fixation of Redistributed Orbital Fat in Transcutaneous Lower Eyelid Blepharoplasty.

Background: While percutaneous external fixation has gained popularity in transconjunctival blepharoplasty due to its simplicity and minimal incision, internal fixation remains the standard approach in transcutaneous blepharoplasty.

Objectives: This study aims to assess the safety and effectiveness of percutaneous external fixation specifically in transcutaneous fat repositioning blepharoplasty.

Methods: From May 2022 to December 2023, a consecutive cohort of 97 patients underwent this surgical technique. Building upon the principles of transconjunctival fat repositioning, the procedure involved a minimal incision targeting the muscle layer, a conservative release of the tear trough ligament, and the repositioning of fat secured with percutaneous external fixation. Surgical outcomes were evaluated using the Barton grading system and FACE-Q scales for patient-reported outcomes.

Results: Following a mean follow-up of 7.2 months (ranging from 6 to 17 months), a resolution of tear trough deformities and eyelid bags was achieved in over 92% of cases. Notably, significant improvements (P < 0.05) were observed in lower eyelid aesthetics as measured by the FACE-Q scale, with a concomitant enhancement in patients' social confidence (P < 0.05). Overall, patients expressed satisfaction with their decision to undergo the procedure (71.0±19.1). Complications necessitating revision surgery included isolated cases of hematoma evacuation, fat injection, excision of excess fat, and skin excision.

Conclusions: External fixation in transcutaneous blepharoplasty is technically less complex and minimally invasive, effectively securing transposed fat pedicles safely, presenting a viable alternative to conventional fixation techniques.