UNASSIGNED: Tear trough deformity is one of the most common complaints in clinical settings. The correction of this groove is challenging in facial rejuvenation. The lower eyelid blepharoplasty varies with different conditions. A novel approach of using orbital fat in the lower eyelid to increase the volume of the infraorbital rim with granule fat injection has been applied in our institution for more than 5 years.
UNASSIGNED: This article aims to describe the detailed steps of our technique and verify its effectiveness by a cadaveric head dissection after surgical simulation.
UNASSIGNED: In this study, a total of 172 patients with tear trough deformity underwent lower eyelid orbital rim augmentation with fat filling in the sub-periosteum pocket. According to Barton\'s grades, 152 patients underwent lower eyelid orbital rim augmentation with orbital fat filling, 12 patients had it combined with autologous granule fat from other body parts, and 8 patients received only transconjunctival fat removal to correct tear trough.
UNASSIGNED: The modified Goldberg score system was used to compare preoperative and postoperative photographs. Patients were satisfied with the cosmetic results. Excessive protruding fat was released, and the tear trough groove was flattened by using autologous orbital fat transplantation. The lower eyelid sulcus deformities were well-corrected. To further illustrate the anatomical structure of the lower eyelid area and injection layers, six cadaveric heads were used for surgical simulation and demonstrated the effectiveness of our technique.
UNASSIGNED: This study indicated that the infraorbital rim could be increased by transplanting orbital fat to the pocket, which was dissected under the periosteum, and the procedure has been verified as reliable and effective.
UNASSIGNED: Level II.

Even though the tear trough (TT) deformity is only 2 cm in length, it can give a worn, even haggard appearance on the face. The authors developed a novel approach and presented findings from the clinical effect.
Between February 2018 and January 2021, the medical records of patients treated with autologous fat injection for TT deformity were researched. The fat was placed under the orbicularis oculi muscle with a sharp cannula. During that period, the TT ligament was also released with the cannula. After the fat was injected entirely, we still needed to repeatedly puncture this ligament to release it until there was no puncture resistance. Improvement was evaluated by measuring patients\' and investigators\' global aesthetic improvement scale.
152 of 173 patients completed the follow-up plan and were enrolled in this study. The most common complications reported were temporary swelling and lumpiness. At 1 month, 3 months, 6 months, 12 months, and 24 months, the satisfaction rate of patient self-assessment was 93.4%, 89.5%, 86.8%, 84.3%, and 82.4%, respectively. The Investigator Global Aesthetic Improvement Scale showed 94.1% of patients\' improvement after one month, 83.6% after three months, 78.3% after six months, 75% after 12 months, and 71.8% after 24 months.
Fat injection based on TT ligament release to correct TT deformity is a novel, easy and effective treatment that deserves to be further used.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

OBJECTIVE: Tear trough deformity (TTD) is becoming a growing concern for those seeking facial rejuvenation, and various treatment strategies have been reported. Among treatment options is micro-autologous fat injection, which appears to be an effective approach to recontour the tear trough in the young. The study we present here investigated the reliability and effectiveness of two-dimensional fat injections (TDFI) in the treatment of young patients with TTD.
METHODS: This study evaluated patients with TTD who underwent TDFI between December 2018 and December 2020. The proposed procedure involved ligament releasing and fat injection into the tear trough in two different directions.
RESULTS: The average age of the 102 enrolled patients was 25.9 ± 3.8 years. Significant improvement and maintenance of TTD were observed during the follow-up period (13.2 months average) with no major complications being observed. Improvement of dark cycles and enhanced aegyo sal were observed. Patient satisfaction based upon self-administered post-procedure questionnaires disclosed that 58.8% were very satisfied, 38.2% were satisfied, and 2.9% neutral with the results.
CONCLUSIONS: Two-dimensional fat injections is an effective and reliable method with high satisfaction and low risk of complication. Long-term results demonstrated its utility for young-type TTD.

In Asia, young patients undergo pan-facial fat injection for facial contouring rather than rejuvenation. Although the procedure is widely performed, there is no singular approach that has been shown to have consistent results. The author\'s approach based on the facial fat compartment theory is presented here. The injection area is classified into functional zones and transition zones. A retrospective review was performed to evaluate the effectiveness of this approach. Satisfactory results were achieved in 96% of cases. In the author\'s view, this approach is safe, easy to learn, and produces satisfactory stable aesthetic results based on the facial fat compartments.

BACKGROUND: There have been several reports of patients experiencing cerebral embolisms following the injection of autologous fat into the face during cosmetic surgery. These embolisms likely resulted from unintentional introduction of fat particles into facial arteries, which then reached the cerebral arteries by retrograde motion.
METHODS: We describe here a patient who developed an internal carotid artery (ICA) embolism after autologous fat injection for temporal augmentation. To our knowledge, this is the first report of a pathologically proven ICA embolism after fat injection into the face.
CONCLUSIONS: Our results suggest that the fat particles reached the cerebral arteries via a previously unknown pathway.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: Autologous facial fat injection is becoming popular around the world. Semiliquid fat grafts are used for correction of deformities or aesthetic purposes. Fat transfer is a mini-invasive surgical procedure, but causes severe complications occasionally.
METHODS: A 30-year-old female patient presented to our hospital with sudden unconsciousness and left limb weakness 8 h after facial fat injection. Brain arteriography (CTA) and venography were performed immediately after her admission. Frontal temporoparietal decompressive craniectomy plus multiple treatments was scheduled for the patient.
RESULTS: The patient was diagnosed with extensive cerebral infarction of the right hemisphere. CTA showed that both external and internal carotid arteries were obstructed. A sectional filling defect could be seen at the telecentric segment of the right carotid artery. No development was observed during the full course of the treatment at the carotid bifurcation, external carotid artery, or internal carotid artery.
CONCLUSIONS: Routine cosmetic procedures of facial fat injections could cause devastating and even fatal complications to patients.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors www.springer.com/00266.