Improving Mid-Cheek Deficiency and Tear Trough Deformity Using a Hammer-Shaped Orbital Fat Transposition: A Single Centre Review of 523 Patients

Background Tear trough deformity and midcheek flatness frequently coexist, particularly in East Asian patients. Conventional orbital fat repositioning techniques often provide limited midcheek projection and may be technically demanding through a transconjunctival approach. Objectives The authors describe and evaluate a modified technique combining hammer-shaped orbital fat reconstruction with Z-shaped semi-fixation to simultaneously correct tear trough deformity and midcheek deficiency. Methods A retrospective case series of 523 consecutive patients undergoing transconjunctival lower blepharoplasty using this technique was performed. Clinical outcomes were assessed using the Barton grading system and patient-reported satisfaction, with a mean follow-up of 8.5 months. Results All patients demonstrated improvement of at least one Barton grade postoperatively. Overall aesthetic satisfaction was rated as good by 89.1% of patients. Complications were uncommon and self-limited, with no cases of lower eyelid malposition or scleral show. Conclusions In this retrospective series, hammer-shaped orbital fat repositioning with Z-shaped semi-fixation was associated with improvement in tear trough severity and patient-reported aesthetic satisfaction, with a low short-term complication rate. This approach may represent a practical option for selected patients with tear trough deformity and midcheek deficiency, although objective volumetric assessment and longer-term comparative studies are needed.