LOWER BLEFAROPLASTY WITH FAT PADS REPOSITIONING : CASES SERIES
The procedures were performed in a hospital setting under local anesthesia. Infiltration: lidocaine solution 2% and epinephrine 1: 100,000, initiated in the topography of the infraorbital nerve, followed by infiltration of the entire lower eyelid and lateral portion of the superior orbital rim. the procedure, the anesthetic block was reinforced at the moment of manipulation of the fat pads.
Incision: subciliary was with myocutaneous flap and dissection in the avascular plane anterior to the septum orbital border. Release of the orbicularis oculi origin from the orbital border superficially to the periosteum and up to 5 mm to release the tear through.
Fat pads dissections : medial and central were dissected leaving a pedicle and then transposed to the deformity level and sutured into the periosteum with 5-0 Nylon. Resection of the lateral was chosen, since it is slightly more fixed in relation to the others, which implies a more limited transposition.
After completing the first stage (treatment of fat pads and nasojugal sulcus), the procedures of canthal support were performed. Canthopexy was done as follows: through the superior blepharoplasty incision, or through a small super-lateral incision, a 5-0 nylon cord was passed, transferring the superficial lateral canthal ligament and a lateral segment of the inferior tarsal plaque. The wire was returned to the entry point at the super-lateral orbital rim through a needle, suturing it into the periosteum at pupil level. It is very important that the traction to raise the lateral corner lies flat below the orbicularis muscle and follows the curvature of the lower eyelid, avoiding the separation of the eyelid border of the eyeball. About 1 to 2 millimeters of the lower limb should be covered.
Finally, after the skin excision was delimited, the skin was resected exclusively, preserving the muscular portion of the myocutaneous flap, followed by suturing of this orbicularis muscle strap to the periosteum of the orbital rim in a slightly super-lateral vector. The skin suture was performed with 4-0 nylon, intradermal suture.
In the postoperative were prescribed antibiotic, anti-inflammatory and analgesic, as well as lubricating eye drops and ophthalmic ointment. Patients received resting guidelines, use of sunglasses for eye protection against trauma and radiation, and use of cold compresses for 72 hours. The stitches were removed between 5-7 days, at which point local lymphatic drainage began. Weekly returns were established in the first month, and a return to 90 and 120 days.