Application of orbital septum-orbital fat composite flap in the repair of lower eyelid bags with tear trough

SU Ritai; HU Chunmei; WANG Xiaolei; WANG Tongmin

doi:10.3969/j.issn.1673-7040.2025.05.004

Abstract：Objective To explore the efficacy of orbital septum—orbital fat composite flap in correcting lower eyelid bags com-bined with tear trough deformity.Methods A retrospective analysis was conducted on the clinical data of patients who underwent external orbital fat release and repositioning surgery at the Department of Plastic Surgery,Beijing Shunyi Hospital,from October 2020 to November 2022.A total of 53 patients were included.The operation was performed through the approach of lower eyelid margin skin.Orbital fat was released,and the orbital septum—orbital fat composite flap was repositioned to correct the deformities of lower eyelid bags,tear troughs,and palpebromalar grooves.Postoperative follow-up was conducted.Through patient self-evaluation(very satisfied,satisfied,dissatisfied,very dissatisfied),and two attending plastic surgeons who did not participate in the operation used the Global Aesthetic Improvement Scale(GAIS)for scoring(-1 to 3 points.The higher the score,the more obvious the improvement effect).Results None of the 53 patients had postoperative complications such as hematoma,lower eyelid retraction,lower eyelid ectropion,no pulling discomfort at the lateral canthus suspension,and no complications such as dry eyes and epiphora.Postoperative follow-up was conducted for 6 to 12 months.Among them,2 cases had swelling for more than 2 weeks;1 case had mild scar hyperplasia at the lateral incision of the lateral canthus,which subsided after 3 months of treatment with topical silicone gel;1 case had mild depression at the junction of the medial nose and face;1 case had mild protrusion of orbital fat.The patient had no further need for improvement and no reoperation was performed.In all the remaining patients,the bilateral lower eyelid morphology was natural and symmetrical after surgery,the eye platform morphology was good,the transition at the palpebromalar junction was natural,and there was no depression.Patient self-evaluation:41 cases were very satisfied,10 cases were satis-fied,2 cases were dissatisfied.Physician GAIS score:The scores of 53 patients were(2.74±0.14)points.Among them,41 cases had 3 points,10 cases had 2 points,and 2 cases had 1 point.Conclusion The repositioning of the orbital septum—orbital fat composite tissue flap by the external approach combined with the suspension of the thickened area of the orbital margin of the lateral canthus of the orbicu-laris oculi muscle flap not only has a significant improvement effect on the relaxation of the lower eyelid skin and soft tissues,as well as the tear trough and palpebromalar groove,but also can improve the depression at the junction of the eyelid and cheek.At the same time,it has an ideal long-term effect and is worthy of clinical promotion and application.