الفهرس 
Surgical Anatomy of the Lower EyelidsOnly 14 pages are availabe for public view
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Abstract
Prominent infraorbital fat pads are the cause of considerable distress in many people as they tend to make their faces look aethetically ”tired”. During aging, this fat tends to protrude.
Many patients desired an office based treatment for their condition as they do not wish to undergo surgery.
It has been demonstrated that an injectable lecithin derived phospholipids called phosphatidylcholine (PPC) can significantly improve the size and appearance of infraorbital fat pad herniation.
This study was carried out on 40 patients, all suffering from prominent fat pads that gave them a tired aged look.
The aim of our study was to compare the effect of PPC and transconjunctival blepharoplasty in reduction of infraorbital fat pads.
Our patients were divided into 2 groups:
Group 1: Those patients were treated by transconjucntival blepharopalsty.
Group 2: Those patients were treated by PPC injection.
Pre operative history and examination were done in order to exclude patients with skin redundancy and lower lid laxity. Patients were followed up in 1st postoperative day, then 1 week, 2 weeks, 1 month, 3, and 9 months.
We found that PPC injection is a fast out patient procedure that is followed by stitching or burning pain for 10 minutes after injection which decrease in frequency when the lower lid is anaesthetized.
But post injection swelling took a long period to be resolved ranging from 1 to 3 weeks. So patient compliance was much less in group 2.
Patient satisfaction was graded from 1 to 10 scale. It was much less in group 2 than in group 1. It was 1/10 in 60% of patients and 5/10 in 40% of patient. No patients were satisfied by 10/10.
Group 1 patients complained of dull aching pain that did not last more than 24 hrs and post operative edema lasting from 3 days to 3 weeks.
Other complications as subconjunctival hemorrhage and ecchymosis occurred in group 1 but not in group 2. Patients were much more satisfied in group 1 as most of them scored their satisfaction to be 10/10.
We tried to avoid occurrence of complications of transconjunctival blepharoplasty in the following ways:
1. Meticulous hemostasis was maintained by using bipolar cautery to avoid orbital hemorrhage. Also postoperative ice packs were put on globe.
2. The incision was made at least 4 mm inferior to the inferior punctum to avoid damage of the canaliculus and avoid epiphora.
3. Only the fat that protruded through the incision was removed and excision was not extended posterior to the level of inferior orbital margin in order to avoid postoperative sunken globe.
4. Care was taken not to injure the inferior oblique muscle to avoid postoperative diplopia.
5. We instructed the patients to do upward massage of the lower eye lid to avoid postoperative wrinkles.
from our study we recommend transconjunctival blepharoplasty as a radicle treatment of lower lid fat herniation in patients with no skin redundancy or lower lid laxity keeping in mind the complications of the operation to avoid its occurrence.
Our impression of phosphatidylcholine injection is not very positive as success and patient satisfaction rates were much less than in surgery.