Temporary Orbicular Oculi Palsy After Radio-Frequency Assisted Liposuction (RFAL) Combined with Transconjunctival Lower Blepharoplasty: Case Report and Systematic Review of Complication.

[BACKGROUND] Radio-frequency assisted liposuction (RFAL) is a minimally invasive procedure that harnesses the subcutaneous fat and fascia for thermal skin tightening and subcutaneous tissue remodeling. It has gradually become an ancillary procedure to excisional facial surgeries, such as facelift, liposuction, and blepharoplasty. This study aims to report and summarize the complications of RFAL combination therapy.

[METHODS] We reported two unusual cases of temporary orbicular oculi muscle palsy, asymmetry of blinking, and opthalmospasm after transconjunctival lower blepharoplasty combined with RFAL. In addition, we performed a systematic review of the English literature on complications of RFAL combination therapy.

[RESULTS] The bibliographic search retrieved 16 studies involving 1181 cases conducting ancillary RFAL in the face and neck and retrieved 27 studies involving 2522 cases conducting RFAL in body contouring. The overall complication rate for the RFAL procedure is 5% (range 2-10%) in the face and neck and 9% (range 5-15%) in body contouring. Periocular nerve injury has not been reported before; however, marginal mandibular neuropraxia is around 0.9% (range from 0 to 4.6%), and deep burn has been reported independently as case series. No complication of RFAL/transconjunctival lower blepharoplasty combination therapy has been reported due to a lack of relevant studies.

[CONCLUSIONS] RFAL is an ancillary procedure for mild to moderate skin laxity with an acceptable complication rate. However, the protection of motor nerves during RFAL and transconjunctival lower blepharoplasty should always be considered. The suitable energy delivered and rational access incision ports are all necessary for a safe outcome.

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