Orbicularis Paresis After Fat Transposition for Tear Trough Deformity.
Juliana Albano de Guimarães, Antonio Augusto Velasco E Cruz
✦ AI-curated · Sources linked
Case in brief
Two patients developed unilateral orbicularis oculi paresis after lower blepharoplasty with supraperiosteal orbital fat transposition for tear trough deformity. Videos obtained 2 weeks after surgery showed reduced blink amplitude in the affected eye: patient 1, OD 3.14 mm versus OS 8.43 mm; patient 2, OD 4.33 mm versus OS 8.50 mm. By 6 months, blink amplitude was symmetrical in both patients, and symptoms of ocular exposure had resolved.
What made this case unusual
The postoperative paresis was documented objectively by reduced blink amplitude and was associated with ocular exposure symptoms, but resolved by 6 months.
Diagnostic / clinical pearl
Motor fibers to the pretarsal orbicularis oculi follow a sub- and intramuscular course in the medial lower eyelid; surgery in this region may injure them and cause paresis.
Why it matters
The authors suggest that a subperiosteal approach to orbital fat transposition may help avoid this complication.