What is Transconjunctival Open Composite Fat Grafting?
- Asked by Vickisue in Florida
- 4 years ago
First let me thank you for suggestions on revision eyelid surgery. It has taken me 7 years to get here. You mentioned Transconjunctival Open Composite fat grafting. Is it another form of injectable filler? Please explain.
I have done much reading, find injectable filler is only a temporary fix, and most fillers are absorbed. Even your own body fat leaves only a small percentage permanantly behind.
If yours is a fat transfer, much like a skin graft, only fat strip graft placed under skin, it is supposes to be most effective. Finding a surgeon to perform this, not so much. I travel to Cape Cod annually.
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What is Open transconjunctival composite fat grafting?
Without getting into the relative merits of open versus injectable fat grafting, here's a definition.
By "open" it is meant that an incision is made. This is in contrast to injectable technique, where a needle is used to introduce the graft.
Transconjuctival means that the tissue is introduced through the conjunctiva, which is the inside layer of the eyelid, that which is in contact with the globe of the eye.
Composite tissue has two or more types of tissue layers. Examples are dermis-fat grafts, cartilage-skin grafts, etc. In this case, the graft is usually dermis-fat.
Fat can be inserted as micro droplets, as is succesfully done by many, or as a layer of tissue. Whether fat remains alive or not depends on the fat tissue getting a source of blood supply in a timely manner.
Dr. Seckel's otherwise informative answer is no completely accurate in the fourth sentence where he states "Fat injection techniques kill a great many of the injected fat cells so that survival of the fat is very difficult to predict. In addition lumps and irregularities are common following fat injections in the eyelid area-the eyelid skin is so thin that any irregularity beneath the skin is very visible."
This is indeed true in inexperienced hands, however I, and many others who follow techniques well described and codified by Sidney Coleman, have years of excellent track record.
Conversely, many others who have attempted Dr. Seckel's technique have not had as reliable and expert results as he has.
Open composite grafting is not an injection but a piece of fat is surgically transplanted
Injection techniques around the eyes are "blind procedures" and accuracy is difficult to achieve.
Injections around the eyes are traumatic and often leave visible lumps and discoloration of the eyelid skin.
Blindness has been reported following filler injections around the eyes-the filler material enters a blood vessel and disrupts blood supply to the retina.
Fat injection techniques kill a great many of the injected fat cells so that survival of the fat is very difficult to predict. In addition lumps and irregularities are common following fat injections in the eyelid area-the eyelid skin is so thin that any irregularity beneath the skin is very visible.
For these reasons and to achieve the best result when treating hollow eyes after blepharoplasty or treating dark circles under the eyes, I use a fat transplantation technique in which a whole piece of fat of proper size to achieve restoration of volume is surgically transplanted under direct vision into the appropriate position, through a small laser incision on the inside of the eyelid. Placing the incision here avoids disrupting the lower eyelid support by making an external incision and cutting through the muscle. The later technique causes the sad eyed look or ectropion.
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