Objective:To evaluate the cosmetic outcomes of non-eyebag associated tear trough deformities (TTDs) using the transconjunctival lower eyelid blepharoplasty with release of the tear trough ligament (TTL) and orbital septum fat reposition.Methods:Non-eyebag associated TTDs patients who received the transconjunctival lower eyelid blepharoplasty with release of TTL and with reposition of the orbital septum fat flap internally fixed to the premaxillary-prezygomatic space were retrospectively reviewed at the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2019 to April 2020. The "Hirmand" types of TTDs were classified preoperatively based on the digital photography. Tear trough rating scale (TTRS) introduced by Sadick was used to assess TTDs before and after surgeries based on depth of the trough, hyperpigmentation, prolapse of nasal fat pads/pockets, and lower eyelid skin rhytidosis. "Barton" grading system was used to evaluate demarcation of orbit-cheek junction area preoperatively and postoperatively. Ultimate surgical outcomes of TTDs were assessed by TTRS, Barton and patient self-assessment scores. Patients were followed up postoperatively and the complications were filed. Matched samples t-test (SPSS 20.0 software) was used for statistical analysis to compare TTRS scores pre- and post-surgery. Results:A total of 79 patients with bilateral TTDs were enrolled, including 24 men and 55 women. Their age ranged from 19 to 38 years old (average, 25.7 years old). Edema or congestion in conjunctiva presented in all patients within 3 days after surgery. Slight eyelid skin ecchymosis, lower eyelid edema or asymmetry was presented in 11 cases, and they all recovered in 1-2 weeks. No other complications occurred. The follow-up period ranged from 5 to 13 months (average, 8.5 months). TTRS scores between pre- and post-surgeries demonstrated no significant difference in Hirmand type Ⅰ ( P>0.05), but presenting significant difference both in Hirmand type Ⅱ and Hirmand type Ⅲ ( P<0.01). All cases (33) in Hirmand type Ⅰ graded as Barton 1 pre-surgery were improved to grade 0 post-surgery. There were 35 cases categorized as Hirmand type Ⅱ. Among them, 7 (20%), 25 (71.4%) and 3 cases (8.6%) were graded as Barton 1, 2 and 3 pre-surgery, respectively. Postoperatively, they were improved to Barton 0 (30 cases, 85.7%) and 1 (5 cases, 14.3%), accordingly. There were 11 cases categorized as Hirmand type Ⅲ, which included 6 cases graded as Barton 2 and 5 cases graded as Barton 3. After surgery, they were improved to Barton 0 (2 cases, 18.2%), Barton 1 (5 cases, 45.5%) and Barton 2(4 cases, 26.3%). As to overall cosmetic satisfaction, 78.5% (62/79), 17.7% (14/79) and 3.8% (3/79) were self-assessed as good, moderate and poor by the patients, respectively. Conclusions:Transconjunctival lower eyelid blepharoplasty with release of tear trough ligament and fat reposition can achieve satisfactory lower eyelid rejuvenation in tear trough deformities not associated with eyebags.

Objective:To evaluate the cosmetic outcomes of non-eyebag associated tear trough deformities (TTDs) using the transconjunctival lower eyelid blepharoplasty with release of the tear trough ligament (TTL) and orbital septum fat reposition.Methods:Non-eyebag associated TTDs patients who received the transconjunctival lower eyelid blepharoplasty with release of TTL and with reposition of the orbital septum fat flap internally fixed to the premaxillary-prezygomatic space were retrospectively reviewed at the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2019 to April 2020. The "Hirmand" types of TTDs were classified preoperatively based on the digital photography. Tear trough rating scale (TTRS) introduced by Sadick was used to assess TTDs before and after surgeries based on depth of the trough, hyperpigmentation, prolapse of nasal fat pads/pockets, and lower eyelid skin rhytidosis. "Barton" grading system was used to evaluate demarcation of orbit-cheek junction area preoperatively and postoperatively. Ultimate surgical outcomes of TTDs were assessed by TTRS, Barton and patient self-assessment scores. Patients were followed up postoperatively and the complications were filed. Matched samples t-test (SPSS 20.0 software) was used for statistical analysis to compare TTRS scores pre- and post-surgery. Results:A total of 79 patients with bilateral TTDs were enrolled, including 24 men and 55 women. Their age ranged from 19 to 38 years old (average, 25.7 years old). Edema or congestion in conjunctiva presented in all patients within 3 days after surgery. Slight eyelid skin ecchymosis, lower eyelid edema or asymmetry was presented in 11 cases, and they all recovered in 1-2 weeks. No other complications occurred. The follow-up period ranged from 5 to 13 months (average, 8.5 months). TTRS scores between pre- and post-surgeries demonstrated no significant difference in Hirmand type Ⅰ ( P>0.05), but presenting significant difference both in Hirmand type Ⅱ and Hirmand type Ⅲ ( P<0.01). All cases (33) in Hirmand type Ⅰ graded as Barton 1 pre-surgery were improved to grade 0 post-surgery. There were 35 cases categorized as Hirmand type Ⅱ. Among them, 7 (20%), 25 (71.4%) and 3 cases (8.6%) were graded as Barton 1, 2 and 3 pre-surgery, respectively. Postoperatively, they were improved to Barton 0 (30 cases, 85.7%) and 1 (5 cases, 14.3%), accordingly. There were 11 cases categorized as Hirmand type Ⅲ, which included 6 cases graded as Barton 2 and 5 cases graded as Barton 3. After surgery, they were improved to Barton 0 (2 cases, 18.2%), Barton 1 (5 cases, 45.5%) and Barton 2(4 cases, 26.3%). As to overall cosmetic satisfaction, 78.5% (62/79), 17.7% (14/79) and 3.8% (3/79) were self-assessed as good, moderate and poor by the patients, respectively. Conclusions:Transconjunctival lower eyelid blepharoplasty with release of tear trough ligament and fat reposition can achieve satisfactory lower eyelid rejuvenation in tear trough deformities not associated with eyebags.