Enophthalmos: Exploration of Quantitative Treatment With Retro-Orbital Fat Globules Injection

Abstract

Craniomaxillofacial and plastic surgeons are often confronted with patients who present with enophthalmos caused mainly by trauma. In many patients, one-stage reconstruction repairs only the bony orbit, leaving intact the disfiguring enophthalmos. Thus, some filler is needed to restore the normal volume of the orbit. The authors describe a technique to correct such deformation safely and effectively. Data were collected from 30 enophthalmic patients (average age 36.67 ± 11.66 years) who underwent retro-ocular injections of fat globules between August 2014 and July 2018. CT helped identify a safe injection site, and specific CT measurements quantified the volume of fat globules required. There was a significant difference between the preoperative and postoperative values for lateral orbital protrusion (P < .01), superior orbital protrusion (P < .01), and orbital volume (P < .01). Most patients were satisfied with the outcome. There were no significant complications. Injecting fat globules into the retro-orbital area is an effective technique for correcting enophthalmos deformity.

Retrobulbar Filling for Enophthalmos Treatment in Dogs: Technique, Description and Computed-Tomographic Evaluation. Preliminary Cadaveric Study

“…However, although M 1 allows the assessment of the rostral and lateral eyeball advancement with a single measurement, M 2 provides more defined anatomical landmarks and makes it easier to compare the pre-and post-injection series. Our methods are similar to the lateral and superior protrusion indexes described by Ye et al [7] in human medicine and confirm the usefulness of CT in pre-operative planning and evaluation of the degree of correction of enophthalmos.…”

“…In human medicine, only a few studies estimated the amount of fat to be injected before the retrobulbar filling [7,8]. In others, the amount of autologous fat to be injected was at the clinician's discretion according to the aesthetic improvement achieved [9,[11][12][13].…”

“…In human medicine, autologous fat intraconal injection (retrobulbar lipofilling) for enophthalmos resolution, mainly resulting from blow-out fractures or tumor resection, is well-described with excellent results and a low complication rate [7][8][9][10][11][12][13]. Among diagnostic imaging modalities, magnetic resonance imaging could provide detailed information regarding the nature and extent of concurrent soft tissue injuries within the retrobulbar space [14,15].…”

Investigation of the Orbital Arterial Distribution Using Image Superimposition to Determine Safe Zones for Retrobulbar Injection and to Prevent Filler Complications

“…Considering that enophthalmos is usually caused by posterior and inferior displacement of the content within the orbit, many surgeons consider retrobulbar injections to be preferable, within the cone of the extraocular muscles. 21,22 Considering that the mean diameter of the eyeball if 25 mm, 23 the ideal technique for transcutaneous retrobulbar filler injection is inserting a 25-gauge needle just above the orbital rim at 4 o’clock (for the left side) via a transcutaneous approach (Fig. 4, above ).…”

Widening Aging Eyes and Ending Outdoor Tearing with Retrobulbar Injections of Dermal Fillers

“…A Chinese team reported recently on 30 patients after traumatic enophthalmos, who underwent retro-ocular injections of fat globules. 23 All patients needed several fat injection sessions.…”