Objective Comparison of Nasojugal Fold Depth and Lower Eyelid Length After Fat Excision Versus Fat Transpositional Lower Blepharoplasty.

Background: Lower blepharoplasty is one of the most commonly performed aesthetic surgeries in the world. However, there are no studies to directly compare patients who had fat excision vs fat transposition.

Objectives: The authors sought to compare and contrast aesthetic results of fat excisional and fat transpositional lower blepharoplasty.

Methods: A retrospective review was conducted of 60 patients (120 eyelids) who underwent transconjunctival lower blepharoplasty, either with fat excision or fat transposition into a preperiosteal plane. Marginal reflex distance-2, lower eyelid length, nasojugal fold depth, and pretarsal orbicularis definition were measured.

Results: Mean follow-up was 5.6 months. Mean marginal reflex distance-2 did not significantly differ after either fat excision or fat transposition. Mean lower lid length decreased after fat excision only (P < 0.001), and postoperative fat excision patients had a shorter lower eyelid length than patients who underwent fat transposition (13.5 ± 2.1 mm vs 16.1 ± 1.9 mm, P < 0.0001). Pretarsal orbicularis definition increased after both surgeries (P < 0.001), and the groups did not differ (1.0 ± 0.8 vs 1.1 ± 0.9, not significant). Mean nasojugal fold depth was effaced after surgery in both groups (P < 0.001), although the nasojugal fold was significantly more effaced after fat transposition (1.5 ± 0.7 vs 0.48 ± 0.6, P < 0.001).

Conclusions: In lower blepharoplasty, fat excision resulted in a shorter lower eyelid, and fat transposition resulted in a more effaced lid-cheek junction. Surgeons should be able to balance both techniques to deliver a customized aesthetic result.

Unlabelled: Level of Evidence: 3.