title: Correction of severe enophthalmos by simultaneous fat grafting and anatomic orbital reconstruction.
abstract: BACKGROUND
  Secondary enophthalmos correction, especially in severe cases, represents a surgical challenge. The complex injury pattern involving the hard and soft tissue warrants individualized multimodality treatment strategies. Even with seemingly successfully surgical execution, relapse or incomplete correction of globe position can occur. In an attempt to improve ability for correction, we have implemented concurrent endo-orbital fat grafting and orbital framework reconstruction. The purpose of this study is to describe our treatment approach and objectively analyze the results.
  
  
  METHODS
  Preoperative and postoperative clinical examinations, Hertel measurements, and radiologic imaging were recorded. Orbitometric measurements were performed using a three-dimensional postprocessing software (SurgiCase; Materialise, Leuven, Belgium). A follow-up period of at least 6 months was taken for final evaluation.
  
  
  RESULTS
  Postoperatively, all patients showed a significant improvement of the globe's position. Neither visual impairment nor disability of globe motility was seen. Hertel and three-dimensional orbitometric measurements showed significant (P < 0.05) globe projection improvement representing a mean of 4.2 and 3.7 mm. Orbital volume (25.65 mL) significantly decreased after surgery (22.98 mL).
  
  
  CONCLUSIONS
  Alloplastic orbital floor reconstruction in combination with endo-orbital fat grafting represents an excellent method to achieve adequate globe support and positioning even in secondary enophthalmos correction.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Philipp
authors.initials: P
authors.lastname: Metzler
authors.forename: Harib H
authors.initials: HH
authors.lastname: Ezaldein
authors.forename: Miles J
authors.initials: MJ
authors.lastname: Pfaff
authors.forename: Yassmin
authors.initials: Y
authors.lastname: Parsaei
authors.forename: Derek M
authors.initials: DM
authors.lastname: Steinbacher
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D015841:Enophthalmos / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies