In Reply We sincerely appreciate the interest of Huggins and colleagues in our study.1 We completely understand their opinion and their reasoning. Despite the low incidence rates, eyelid retraction and tethering are important drawbacks of fat transposition.2 These might be related to the inadequate skills of individual surgeons rather than to problems related to the technique itself. However, these complications are not simply anecdotal. In fact, several patients have visited our clinic because of complaints about previous transconjunctival lower blepharoplasty performed in other clinics. Besides recurrence, the main complaints were hollowness and deepening of the tear trough deformity in fat removal, and eyelid retraction and motility disturbance in fat reposition. However, we acknowledge that eyelid retraction and tethering can be overcome with a skillful technique.3
Kim HS, Kim BR, Youn SW. Pedicled Fat Transposition vs Free-Fat Grafting for Lower Blepharoplasty With Volume Preservation—Reply. JAMA Facial Plast Surg. Published online June 27, 201921(5):464–465. doi:10.1001/jamafacial.2019.0480
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