Abstract

Objectives: We propose a new technique to prevent residual fat by complete release of the septal fat and precise shape (integration) of the fat pedicles. Based on this technique, we found that it can release more septal fat for tear trough and mid-face augmentation, enhancing the filling effect. Introduction: After the introduction of septal fat release and reposition in transconjunctival lower blepharoplasty (TCLB), few studies have addressed the thorough release of orbital fat tissue to adequately augment the tear trough and midface concavity. Additionally, limited literature exists regarding residual or recurrent eye bags and corresponding preventive measures after fat release and repositioning in transconjunctival lower blepharoplasty (TCLB). Materials / method: From December of 2021 to May of 2023, 105 patients were treated with the full integration and repositioning of septal fat tissue (F.I.R.S.T.) technique in TCLB. This study observed the effectiveness of correcting tear trough deformity (TTD) and mid-cheek depression using the technique, and postoperative complications were also recorded. Results: This mean age was 34 years with a mean follow-up of 13 months. The average operation duration was 55 ± 7.1 minutes . Among the cases, 70 eyes (33.33%) had Grade I TTD, 92 eyes (43.8%) had Grade II TTD, and 48 eyes (22.9%) had Grade III TTD. Successful correction was achieved in all Grade I cases, with 75 eyes (81.52%) improving to Grade 0 among Grade II cases. For Grade III cases, 28 eyes (58.33%) improved to Grade 0. No severe hematoma, diplopia, scleral show, ectropion, upper and lower eyelid concavity, enophthalmos, ocular motility disturbance or uneven midface was observed in any patients. Conclusion: The F.I.R.S.T. technique effectively prevents fat residual in the lower eyelid area and provides favorable postoperative filling effects in the tear trough and mid-cheek region.