Comparison of outcomes between simultaneous fat grafting and filler injection with transconjunctival fat removal for improvement of the lower eyelid contour

ABSTRACT

Background@#Mid-facial aging is associated with various changes, particularly around the lower eyelid, where these changes manifest as herniation of orbital fat, sagging of soft tissue around the zygoma, and the tear trough deformity. We improved the lower eyelid contour via transconjunctival orbital fat removal and the use of either an autologous fat graft or filler injection. @*Methods@#Between June 2016 and July 2018, 100 patients aged 23–48 years underwent autologous fat grafts (group A 50 patients, 100 eyes) or filler injections (group B 50 patients, 100 eyes). The mean follow-up period was approximately 3 months. The results of surgery were evaluated using a visual analog scale (VAS) to assess patient satisfaction and with preoperative and postoperative scores determined by three plastic surgeons according to the grading system for lower eyelid contour deformity devised by Barton et al. @*Results@#The mean VAS score was 8.48 in group A and 8.92 in group B, but the difference was not statistically significant. The percentage of postoperative improvement from preoperative grade I deformity to grade 0 was 97.7% in group A and 100% in group B. The percentage of improvement from preoperative grade II deformity to grade 0 was 96.0% in group A and 96.1% in group B, and the percentage of improvement from grade III deformity to grade 0 in was 66.7% in group A and 75% in group B. @*Conclusions@#Filler injection can be an alternative to fat grafting for improvement of the lower eyelid contour after transconjunctival orbital fat removal.