E-PTFE Patch Orbital Septum Strengthening Technique In Low-lid Blepharoplasty

Background of study: The concept of preserving and utilizing the orbital fat in the lower blepharoplasty has been proposed for more than 10 years. The classic technique of Hamra's solve the problem of infraorbital depression or tear-trough deformity and restore a younger appearance of the orbit-cheek transition. However, this technique has not effectively strengthen the orbital suptem, which often degrades with age in the oriental baggy eye. So after the surgery, the released orbital fat will keep coming down and forward, inducing a recurrent herniation and orbital depression. It's not good for the long-term effect. In order to solve this problem , we invent a new technique using E-PTFE patch to strength the orbital septum and control the fat released. Through this technique , we not only rejunvenate the orbit-cheek complex but also maintain orbital fat volume and the eye ball position. After 3 year's follow-up in the 102 cases, the results turn to be satisfactory.Materials: E-PTFE patch produced by Shanghai Suo-Kang medical implants co.,ltd. Before using, the patch was trimmed to a crescent-shaped sheet inappropriate size.Methods: In transcutaneous low-lid blepharoplasty, after the completion ofseparating the musculo-cutaneous flap and exposing the orbital septum and thearcus marginalis, we cut open the lower margin of the septum to the arcusmarginallis and release the orbital fat to the region within the extent of 1cm. Thenwe implant the trimmed patch into the space between the septum and thesuborbicularis fascia. The lower margin of the patch is sutured to the infraorbitalperiosteum, with the superior margin unsutured.Results: After a median follow-up time of 2.5 years (range 1 to 3) in 102cases(10 cases lost), we observed that the results were good in 89 cases till the lastfollow up. 2 cases suffered long-term edema recovered naturally. Only 1 case hadto be reoperated due to recurrence. No infection and foreign body reaction wereincluded.Conclusion: The E-PTFE patch technique, in our experience, is a good methodto strength the orbital septum and middle lamella of the eyelid to restore thenatural younger appearance of the lower-lid. The long-term effect seemed to begood with relatively few complications and low recurrence rate.