Volume Correction for Nasojugal Groove With Blepharoplasty

Many techniques have been offered for improvement or correction of progressive fat atrophy of the face, particularly in the lower lid and nasojugal groove area, where subcutaneous fat loss causes deepening and an appearance of "dark circles" under the eyes. This is also seen in the lateral part of the lower lid orbital area as a depression, which seems to worsen with age. The author describes his experience in hundreds of cases of lower lid blepharoplasty with correction of tear trough deformity, in which he has noted that there is only a short distance (less than 1 mm) between the skin surface and the orbital rim, due not to the orbital septum attachment but to a special fascia layer on the undersurface of the orbicularis oculi muscle. The addition of fat grafting into the orbital oculi muscle at the level of the orbital rim and below lifts away and bolsters the improvement seen with lower lid blepharoplasty alone, to provide a better and more permanent correction of the nasojugal groove area. The author's operative technique is illustrated and discussed in detail.