Ayhan OKUMUS, Abdulkadir CALAVUL
Turkish Journal of Plastic Surgery - 2026;34(4):172-176
Extraconal orbital fat prolapse is common, but intraconal fat prolapse into the subconjunctival space, known as subconjunctival herniated orbital fat (SHOF), is uncommon. This entity is typically located in the superotemporal quadrant, while presentation in other quadrants is extremely rare. We report a case of bilateral inferotemporal SHOF in a 53-year-old male patient who presented with palpebral bags in the lower eyelids. Physical examination revealed a soft, yellowish, mobile mass in the inferotemporal subconjunctival space upon application of pressure and inferior retraction. Magnetic resonance imaging confirmed a low-density mass continuous with the intraconal fat. The patient underwent elective surgery for cosmetic reasons. Surgical excision was successfully performed via a subciliary approach, removing the nasal, central, and temporal fat pads. Histopathological analysis confirmed normal adipose tissue. Postoperative follow-up was uneventful with no recurrence observed within the 1st year. This case is the first to document bilateral inferotemporal SHOF in a male patient presenting with palpebral bags. This unique clinical presentation underscores an atypical manifestation of a rare condition. The subciliary approach proved to be a valuable surgical alternative for this specific location, allowing for simultaneous correction of the palpebral bags and avoiding a conjunctival incision.
