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Acellular Dermal Grafts for Tear Trough Deformity in Revision Lower Blepharoplasty

Russell W. H. Kridel, MD; Angela K. Sturm-O’Brien, MD
JAMA Facial Plast Surg. 2013;15(3):232-234. doi:10.1001/jamafacial.2013.783.
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Despite recommendations in the literature to perform conservative fat resection in lower blepharoplasty, patients are still seen postoperatively with tear trough deformities that can give a “tired” appearance. In these patients, the loss of orbital fat results in loss of support for the globe and a prominent infraorbital rim.1 Revision blepharoplasty is complex, since autologous fat is not available for repositioning in the lower eyelids.

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Figure 1. Lower blepharoplasty with acellular dermal graft. A skin-muscle flap is developed, staying superficial to the orbital septum. An acellular dermal graft is trimmed to fill the hollowing and placed superficial to the septum. The orbicularis oculi is trimmed, the skin muscle flap is trimmed, and the orbicularis oculi is resuspended to the inner periosteum of the lateral orbital rim.

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Figure 2. Four-year follow-up with acellular dermis to correct tear trough deformities. A, 40-year-old white woman with a history of upper and lower transconjunctival blepharoplasty with excessive fat excision 2 years earlier who was seen in consultation to improve the appearance of her lower eyelids. On physical examination, the patient had tear trough deformities bilaterally. B, The patient underwent a lower blepharoplasty with an acellular dermal graft placed between the septum and orbicularis oculi. The patient had a nice resolution of the tear trough deformity at the 4-year follow-up.




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