Evaluation of a compression method for transconjunctival fat removal: safety and surgical utility compared to a conventional traction approach

Background Transconjunctival fat removal (TFR) is a widely practiced aesthetic procedure for lower eyelid bulging, with the traction method commonly used to secure the surgical field. However, this approach carries risks such as lower eyelid skin penetration and extraocular muscle injury. To address these concerns, a compression method that avoids energy devices and enables blunt dissection through orbital compression was evaluated.Methods A retrospective study was conducted of 60 TFR cases performed by a single surgeon between March 2024 and February 2025. Patients were categorized into compression (n=30) and traction (n=30) method groups based on the technique used for surgical field exposure. Postoperative complications were assessed over a 1-month period.Results No significant differences were found in baseline demographics. Postoperative complications occurred in three cases (10.0%) in the compression group and two cases (6.7%) in the traction group (P=0.640). All complications were mild and resolved without reoperation. No severe adverse events, including orbital hemorrhage, infection, or visual impairment, were observed. One case of residual orbital fat in the compression group was attributed to limited visualization due to orbital pressure.Conclusions The compression method demonstrated a safety profile comparable to that of the traction method and may serve as a viable alternative, particularly for less experienced surgeons. It offers a simplified and potentially safer approach for performing TFR, supporting its utility in clinical practice and surgical training.