title: Redraping of the fat and eye lift for the correction of the tear trough.
abstract: BACKGROUND
  Tear trough deformity is very difficult to correct. It can appear at relatively young age and it deepens over the years due to laxity and loss of structural support. We describe a technique for the correction of tear trough deformity and mid-face laxity by means of redraping blepharoplasty and lateral "eye lift".
  
  
  METHODS
  Upper lid markings were made and removal of the excess skin was employed. The herniated fat was removed from the nasal fat pad. Using a subciliary incision the dissection was completed at the level of the orbital rim and the fat was repositioned with 5-0 Monocryl (poliglecaprone 25, Ethicon) sutures at the inner canthus to correct the tear trough. Subsequently, a canthopexy performed to secure the lower eyelid. We then dissected the cheek over the periosteum of the zygomatic bone-arch and the flap was suspended through a tunnel at the periosteum of the upper-lateral orbit by 5-0 Monocryl (poliglecaprone 25, Ethicon) suture.
  
  
  RESULTS
  Thirty-five procedures were performed between 2009 and 2013. Patients were followed for at least one year. Successful correction of the tear trough deformity with middle face elevation was achieved in all patients. Sclera show was noted in 7 patients but resolved over 3-6 months period with no surgical intervention. Diplopia was noted in 1 patient probably due to oedema and was released 4 weeks after the operation. The oedema was prolonged (more than 1.5 month) in 10 patients probably due to the lymphatic stasis. Conjunctivitis was also noted in 2 patients and was released by conservative treatment.
  
  
  CONCLUSIONS
  Our technique of redraping blepharoplasty and mid-face lift describes a relatively new approach for the correction of the tear trough deformity and middle face laxity. It shows stable results for up to 4 years although longer follow-up is needed to confirm the stability of the correction.
authors: OpsisClinical Plastic and Reconstructive Surgery, 48 Anogion St., 71304, Therissos, Heraklion-Crete, Greece. Electronic address: liapjo@yahoo.com.
authors: Ioannis E
authors: IE
authors: Liapakis
authors: Massachusetts Eye and Ear Infirmary - Harvard Medical School, 243 Charles St., 02114, Boston, MA, USA.
authors: Eleftherios I
authors: EI
authors: Paschalis
authors: Artion Plastic Surgery Center, 11 D. Vassiliou St., N. Psyhiko, Athens, 15451, Greece.
authors: George J
authors: GJ
authors: Zambacos
authors: Massachusetts Eye and Ear Infirmary - Harvard Medical School, 243 Charles St., 02114, Boston, MA, USA.
authors: Miriam
authors: M
authors: Englander
authors: Artion Plastic Surgery Center, 11 D. Vassiliou St., N. Psyhiko, Athens, 15451, Greece.
authors: Apostolos D
authors: AD
authors: Mandrekas
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D003231:Conjunctivitis / Q000209:etiology; D004172:Diplopia / Q000209:etiology; D004487:Edema / Q000209:etiology; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015187:Lipectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D009915:Orbit / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D015361:Rhytidoplasty / Q000379:methods
keywords: Blepharoplasty; Mid-face lift; Redraping; Tear trough