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This one-piece strip of fat is generally obtained from a donor area beneath the pubic hair where the fat contains a rich fascial component.
It is implanted behind the intact orbital septum of the upper eyelid as a single piece rather than as a collection of multiple smaller pieces as is done with pearl fat grafting in the lower eyelid.
Normal upper orbital fat exists in precisely this location. In contrast to methods such as superficial needle injection of liposuctioned fat cells under the skin or into the muscle, fasica-fat augmentation occurs at a much deeper but more natural physiologic location.
As a volume enhancer, strip fat is thus superior to injected synthetic or biological materials and provides a smoother contouring for the ovelying skin.
The high fascial component of the graft seems to favor a rapid return of blood supply and also helps to provide a more stable architecture in terms of volume and shape.
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Because the graft is placed into the deeper anatomic location naturally intended for fat (the same area from which fat is removed during blepharoplasty), "take" is usually excellent.
When preexisting anatomical conditions allow the strip fat graft to be placed behind an intact orbital septum, graft survival is consistently good (50-70%). Between 2-4 mm of thickness can be added in a single operation. If volume depletion is advanced, a second surgery may be necessary to obtain the best enhancement.
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