Assessment of the Efficacy of Tear Trough Depression Reconstruction Using an Intraoral Cannula-Guided Puncture for Orbital Septum Fat Flap With the FACE-Q Scale.

Abstract

Objective: Previous corrections of infraorbital and tear trough depression often utilized particulate fat or artificial material fillers, or used orbital septum fat flaps fixed via subcutaneous/epicutaneous knotting through facial puncture, which carried risks of displacement, contour irregularity, and traction. This study aims to investigate a novel surgical technique for correcting infraorbital depression using a cannula-guided intraoral approach to fix a repositioned orbital septum fat flap, assess its therapeutic efficacy and feasibility, and employ the FACE-Q scale for objective evaluation.

Methods: Twenty-nine patients undergoing lower blepharoplasty were enrolled, with a mean age of 48.6 ± 4.5 years. Paired t tests were used to compare FACE-Q scale scores (Eye Appearance Satisfaction, Psychosocial Function, and Self-confidence domains) preoperatively and at 6 months postoperatively. Cohen's d was calculated to assess effect sizes (d > 0.8 indicating a large effect). Multiple linear regression analyzed the impact of preoperative infraorbital depression severity (Hirmand classification grades 1-3) and skin laxity severity (mild/moderate/severe) on the magnitude of postoperative score improvement (Δ). Principal component analysis (PCA) explored the underlying dimensional structure of score changes. Statistical significance was set at P < 0.05.

Results: The cohort included 26 females (89.7%) and 3 males (10.3%). At 6 months postoperatively, all FACE-Q domain scores showed significant improvement compared with preoperative values (all P < 0.001): Eye Appearance Satisfaction improved the most (Δ = 34.40 ± 4.36, Cohen's d = 5.93), followed by Psychosocial Function (Δ = 25.73 ± 3.59, d = 4.85) and Self-confidence (Δ = 23.27 ± 3.78, d = 4.12). Effect sizes far exceeded the 0.8 threshold, indicating highly clinically meaningful improvements. No serious adverse events occurred postoperatively. Multiple linear regression revealed that a higher infraorbital hollowness grade (β = 3.2, P = 0.006) and severe skin laxity (β = 4.1, P = 0.016) were independent positive predictors of improvement in eye satisfaction, with the model explaining 32% of the variance (F = 4.21, P = 0.003). Principal component analysis further revealed that 69% of the variance in score changes was explained by a single principal component (Δ Eye Satisfaction loading 0.94, Δ Psychological Function loading 0.86, Δ Social Function loading 0.85), indicating highly synergistic improvements across dimensions without significant subgroup differentiation patterns.

Conclusion: The technique of guided fixation of the orbital septum fat flap via an intraoral approach effectively corrects tear trough depression, allows for dynamic adjustment, avoids subcutaneous nodules and lower eyelid traction, and represents a safe and feasible autologous tissue correction method worthy of clinical promotion. The FACE-Q scale sensitively reflects multidimensional postoperative benefits.