Advantages of this technique include elimination of external scars, retention of the blood supply for under eye fat and no scarring down of the eyelid.
All the sutures attaching the herniated eyelid fat are placed on the inside of the lower eyelid and advance this fat into the half circle at the eyelid cheek junction."And this, along with the transconjunctival retroseptal dissection planes, should decrease the problems with scarring of the lower lid," says Patrick K. Sullivan, M.D., who presented surgical techniques for this procedure at the American Society of Aesthetic Plastic Surgeons, held here.
"These techniques that we have used have grown out of our studies of the anatomy and also from our knowledge of other techniques that different surgeons have used successfully," says Dr. Sullivan, who has a private practice in Providence, R.I. and is associate professor of plastic surgery at Brown University.
Dr. Sullivan and colleagues at Brown University have studied the anatomy of the tear-trough deformity, determined the anatomic basis and presented their findings at the American Society of Plastic Surgeons Meeting in San Diego, in October 2003 (Sullivan, P. K., Kim, R.Y., Singer, D.P., Woo, A.S. The Anatomic Basis for the Tear-Trough and Crescent Deformity at the Lower Eyelid-Cheek Junction, American Society of Plastic Surgeons Meeting, San Diego, October 2003).
Variety of techniques A variety of techniques have been used by other surgeons to correct this deformity, Dr. Sullivan says, "but the way we have changed ours is that we have no external incisions or sutures placed in the skin — the incisions are all made in the inside of the lower eyelid."
The procedure is performed in an anatomic plane that Dr. Sullivan's group and other surgeons have found to decrease the problems with scar tissue. It prevents scarring of the eyelid into a scarred down abnormal position.
The procedure has been able to eliminate puffy, under-eye circles in three types of patients.
"All types have one thing in common," Dr. Sullivan explains, "they have puffiness of the lower eyelid caused by herniated fat."
The first type of patient has the tear-trough deformity in just the inner portion of the eyelid.
"The deformity only is evident about halfway around the eye," he says.
In the second type, the patient has a crescent deformity at the lid cheek junction where there is a half circle all the way around the underportion of the eye, "and that is the type of deformity that people usually find to be disconcerting," he adds.
The third type has a full crescent deformity but has so much puffiness that you actually have to remove some of the fat in addition to just repositioning it.
The procedure In the procedure, the puffy tissue that is actually herniated fat is brought down to fill in the circles, Dr. Sullivan says.
"The circle is actually a groove, and we fill in this groove with some of that herniated fat, and then, in order to make sure the fat stays in the position that we want it to, it is sutured in with stitches on the inside of the lower lid on the undersurface of the periosteum.