Capsulopalpebral Fascia Hernia Repair for Lower Eyelid Palpebral Bags: A 5–Year Follow–up

Abstract

Abstract: : Purpose: To evaluate the long–term results of capsulopalpebral fascia hernia repair, a fat preservation technique for lower–eyelid palpebral bag blepharoplasty. Methods: 26 patients with bilaterally symmetric palpebral bags consented to undergo standard fat–resection blepharoplasty in one eye and capsulopalpebral fascia hernia repair on the other side. The operative technique for hernia repair was that of transcutaneous subciliary incision and splitting of the septal portion of orbicularis oculi. The septum orbitale was incised, and the herniated fat was returned to the orbit. Finally the capsulopalpebral fascia was sutured to the periosteum of the orbital rim. On the contralateral lower eyelid, a standard fat–resection blepharoplasty was performed. The patients were evaluated at 6 weeks, 6 months, at an average of 5–years. The eye that underwent hernia repair was alternated between patients, and was unknown to the evaluator at the time of follow–up. Patients were evaluated for lower lid position, eyelid mobility, hollowing of the lower eyelid, and any recurrence of palpebral bags. Results: At five years follow–up, four patients who underwent standard fat–resection blepharoplasty experienced recurrences. Two patients who underwent standard fat–resection blepharoplasty and requested further surgical treatment subsequently underwent hernia repair and are doing well with less than one year of follow–up. In the hernia repair group, two patients experienced lateral compartment recurrences and subsequently underwent minor procedures involving small lateral incisions with good results with less than one–year follow–up. Conclusions: Capsulopalpebral fascia hernia repair for palpebral bags has an equivalent or possible lower rate of recurrence and complication as does standard fat–resection blepharoplasty at five years of follow–up. In some patients with large amounts of excess fat, it may be necessary to coagulate or remove a small amount of fat before proceeding with capsulopalpebral fascia hernia repair, as excess fat may place increased tension on the lateral lid margin.

Keywords: eyelid • orbit • wound healing