Clinical Treatment Of Different Tear Trough Deformity

Objective: To review the clinical experiences of treating tear trough deformity with orwithout palpebromalar groove and lower lid bags in168cases from the month of July in2012to March in2013, and summary the individualized treating plans for differentpatients.Methods: Photogragh the patients aged from22to64years old who wanted to improvetheir lower lids aging from the month of July in2012to March in2013. Each patientwas divided into three groups according to our classification system of the tear troughdeformity in basis on the Hirmand’s classification system after being observed by threedoctors independently, and then identified by experienced plastic surgeons. The casesthose were considered had tear trough deformity and were classified into the sameclasses by all observers were positive and put into the corresponding classes. As furtherinvestigate, the controversial photos would be identified by two experienced plasticsurgeons independently, and the cases those were considered had tear trough deformityby three or four persons out of all five observers were positive, while the others werenot selected into our study. Finally, we had168cases (19male and149female). Therewere34cases for Class Ⅰ,45for Class Ⅱ, and89for Class Ⅲ, respectively. Adopteddifferent techniques to correct the tear trough deformity, palpbromalar groove deformityand the lower lids bags according to the different classes of patients.For the patients inClass Ⅰ, we corrected their tear trough deformity with nonsurgical techniques, such asinjecting the hyaluronic acid (HA) filler. And for ClassⅡ, we took the transconjunctiveapproach for all the patients. While fat transposition and grafting, selective release ofthe orbicularis retaining ligament were taken to some of the patients as well. For the lastClass, transcutaneous approach was the treating method we chose.Results: The follow-up period ranged from1to9months. Remarkable improvementsin lower eyelid were achieved. According to Barton’s grading system to analyze thepostperative results, we had the result as follows: in Class Ⅰ,30cases are in Grade0,while4in Grade1and none in Grade2and3; in Class Ⅱ, there were39cases in Grade 0,5in Grade1,1in Grade2, and0in Grade3; and in Class Ⅲ,42in Grade0,43inGrade1,4in Grade2and0in Grade3, respectively. And in Class Ⅰ,33patients out of34were satisfied with the effects, only1patient was satisfied after a second injecting.In Class Ⅱ,3cases out of45were not satisfied with the results, but turnedtheir ideasafter having been given an extra HA injection. There were89cases in Class Ⅲ, inwhich3cases accepted the secondary surgery in order to improve the situation oflacking of symmetry, while another2patients were given the extra HA injection aftertheir surgery. Among all the168cases, postoperative edema and ecchymosis occured inthe early postoperative period on about96%cases, which would resolve withouttreatment in the first month after operation.8cases (5%) experienced chemosis, andwere all successfully treated after the symptomatic treatment.2cases suffered the eyelidand eyeball seperation, but were corrected with early postoperative canthopexy fixation.No ectropion or other severe complications appeared on any of the168cases.Conclusion: After an intensive evaluation and classification before the treating, it isvery effective and necessary to adopt individulized techniques for different tear troughdeformity on the basis of the anatomy.