Augmentation blepharoplasty: a review of 500 consecutive patients.

BACKGROUND: Volume loss in the upper and lower eyelids and in the malar area is now considered a major component of periorbital aging. As classical resection blepharoplasty does not address this loss, filling procedures are becoming increasingly common.

OBJECTIVES: The authors present their experience with periorbital fat grafting in conjunction with routine blepharoplasty to address periorbital aging.

METHODS: Outcomes were retrospectively reviewed for 500 consecutive patients who underwent blepharoplasty in conjunction with the authors' periorbital augmentation technique from January 2008 to September 2011. The augmentation technique was a fine particle fat (microfat) grafting procedure that involved the use of small-diameter cannulae for transfer of autologous fat to the medial part of the upper eyelid, the orbitomalar groove, and the malar area.

RESULTS: Clinical evaluation and review of patient photographs revealed favorable, natural-looking, and long-lasting improvement of the treated areas. Shortcomings of classical resection blepharoplasty, such as hollowing of the upper eyelids, incomplete blending of the eyelid-cheek junction, and persistent deflation of the midface, were avoided; the full and crisp aspect of the upper and lower eyelids seen at a younger age was regained; and the technique was not associated with the complications seen in an earlier patient series. No major complications occurred. Minor complications included bruising and swelling.

CONCLUSIONS: Augmentation of the upper and lower eyelids through microfat grafting can be a useful alternative to existing blepharoplasty techniques. This study documents very natural and pleasing results that avoid the shortcomings of classical resection. Microfat grafting appears to be a valuable and safe alternative to complicated, difficult, and potentially dangerous eyelid and midface rejuvenation techniques.