Correction of tear trough deformity in young patients without eyebags using orbital fat reposition and release of tear trough ligament

BACKGROUND: Tear trough deformity (TTD) is a periorbital hollow extending from the medial canthus to the midpupillary line, which is mainly caused by the traction of the tear trough ligament (TTL). This study aimed to present a retroseptal transconjunctival lower-eyelid blepharoplasty with orbital fat reposition and release of TTL for correcting TTD in young patients without eyebags. METHODS: Seventy-nine young patients with TTD without eyebags receiving the described technique were retrospectively reviewed from September 2020 to April 2023. TTD was preoperatively categorized into different Hirmand types. Cosmetic outcomes were evaluated through tear trough rating scale (TTRS), Barton grading system and patient self-assessment. RESULTS: The average follow-up time was 14.7 months (range, 12-18 months). Average TTRS in Hirmand class I and II were significantly different between pre- and post-operation (p < 0.05), while there was no significant difference in class I (p > 0.05). As to Barton grading system, TTDs in Hirmand class I were all graded as 1 preoperatively and were all shifted to grade 0 postoperatively. In class II, grade 1 (20%), grade 2 (71.4%), and grade 3 (8.6%) TTDs were shifted to grade 0 (85.7%) and grade 1 (14.3%) postoperatively. In class III, grade 2 (54.5%) and grade 3 (45.5%) TTDs were shifted to grade 0 (18.2%), grade 1 (45.5%) and grade 2 (36.3%). The overall patient self-assessed satisfaction was 96.2%. CONCLUSIONS: Retroseptal transconjunctival lower-eyelid blepharoplasty with release of TTL and orbital fat reposition can achieve satisfactory outcomes to correct TTDs without eyebags.