Lower Eyelid Hernia Repair for Palpebral Bags: A Comparative Study

Abstract

The standard treatment for herniated "bags" of the lower eyelid is surgical removal of excess fat. Sachs and Bosniak in 1986 and de la Plaza and Arroyo in 1988 described a new technique for treatment of palpebral bags that consisted of returning the herniated fat to the orbital cavity and retaining it by continuous sutures of the capsulopalpebral fascia either to the dehiscent portion of the orbital septum or to the periosteum of the lower orbital rim. This article reports a prospective study of 26 patients who underwent standard blepharoplasty in one lower eyelid and capsulopalpebral fascia hernia repair in the other lower eyelid. All were evaluated at 6 weeks and at 6 months after surgery, and the outcomes were compared. The results of the two different techniques in the same patient have shown comparable aesthetic outcomes in the treatment of palpebral bags. However, results indicate that the capsulopalpebral fascia hernia repair technique carries less discomfort and pain during the operation and may be less prone to postoperative bleeding and hematoma formation. In addition, in contrast to standard lower blepharoplasty with fat resection, hollowing of the lower lid or potential sunken appearance of the globe may remain absent with capsulopalpebral fascia hernia repair beyond the 6-month period of this study.

Lower Blepharoplasty with Capsulopalpebral Fascia Hernia Repair for Palpebral Bags: A Long-Term Prospective Study

“…[1][2][3][4][5] Such an approach is intuitive, simple, and reliable, and consists of returning adipose tissue to the orbital cavity and retaining it by approximating the capsulopalpebral fascia to the arcus marginalis (the confluence of the periosteum of the inferior orbital rim and the periorbita). In this approach, bulging fat is treated similarly to a direct inguinal hernia, and the repair returns the content of the hernia (orbital fat) to its original location within the orbital cavity.…”

“…3,[5][6][7][8] Not verified by quantitative studies, the perception prevails that fat-preserving blepharoplasty results in a more youthful eye, prevents enophthalmos or a prominent inferior orbital rim, and minimizes the hollowed or sunken look that may result from standard blepharoplasty. [1][2][3][4][5] Figure 2 illustrates typical hollowing of the lower eyelids in a 72-year-old woman before and at 6 months after standard blepharoplasty with fat removal. Figure 3 above shows a 53-year-old patient before standard blepharoplasty with fat removal.…”

“…Our results with 6 months' follow-up were published in this Journal in 1998. 2 Our technique was and has remained essentially that of de la Plaza, in which herniated fat is returned to the orbital cavity and the capsulopalpebral fascia is sutured to the arcus marginalis (the confluence of the periosteum and the orbital septum) of the inferior orbital rim. Our modification of the technique is in using interrupted sutures, whereas de la Plaza describes a running closure 1 for this approximation.…”

Comparison between two surgical techniques for lower eyelid rejuvenation: safety analysis and outcomes

“…The evolution of this procedure has resulted in divergent concepts. Some authors favor the maintenance of the fat bags, others are against touching the orbicularis oculi muscle, and still others recommend muscle cutaneous flaps and ample undermining of the orbicularis oculi muscle [2,4,12,[14][15][16][17][18][19][20][21].…”

Cosmetic Eyelid Surgery From the Patient's Perspective

“…1 Cosmetic blepharoplasty is a commonly performed aesthetic facial procedure. Although only a few studies compare different surgical techniques of blepharoplasty, [3][4][5] no study to date has considered the specific benefits of cosmetic eyelid surgery or answers basic questions that patients commonly ask during the initial preoperative consultation. 6 Communication between the patient and surgeon is crucial to the successful outcome of any cosmetic procedure.…”