Clinical Outcomes and Complications of Fat Repositioning Technique for Tear Trough Deformity

Abstract

The tear trough deformity is a common aesthetic concern, characterized by a hollowing or shadowing under the lower eyelid that gives a tired or aged appearance. It typically results from age-related anatomical changes, including volume loss, descent of the orbital fat pads, and weakening of the orbicularis retaining ligament. Tear troughs may also be present congenitally or appear early in life due to hereditary factors. Fat repositioning, also referred to as transposition or redraping of the lower eyelid fat, has emerged as a preferred surgical technique for correcting this deformity, especially in patients with herniated orbital fat and midface volume loss. Unlike traditional lower blepharoplasty, which involves excision of fat pads, fat repositioning conserves and redistributes the existing orbital fat to fill the tear trough and nasojugal groove, providing a more natural and youthful contour to the midface. Over the years, various surgical approaches to fat repositioning have been developed, including transconjunctival and transcutaneous techniques, with or without the use of supporting structures such as fascia or septal flaps. While fat repositioning has shown favorable aesthetic outcomes and high patient satisfaction, it is not without complications. Reported risks include ectropion, lower eyelid retraction, contour irregularities, asymmetry, hematoma, chemosis, and transient or persistent edema. The clinical outcomes and safety profile of fat repositioning techniques depend on multiple factors such as surgeon experience, patient anatomy, surgical approach, and postoperative care. Given the growing popularity of this technique in aesthetic and reconstructive oculoplastic surgery, it is important to evaluate both its efficacy and potential complications systematically.