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 versus fat transposition.

OBJECTIVE: To compare and contrast aesthetic results of fat excisional and fat transpositional lower blepharoplasty.

METHODS: A retrospective review 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 (MRD2), lower eyelid length, nasojugal fold depth, and pretarsal orbicularis definition were measured.

RESULTS: Mean follow-up was 5.6 months. Mean MRD2 was not significantly different after either fat excision or fat transposition. Mean lower lid length was 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 was increased after both surgeries (p<0.001), and there was no difference between the groups (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 results in a shorter lower eyelid, while fat transposition results in a more effaced lid-cheek junction. Surgeons should be able to balance both techniques to deliver a customized aesthetic result.