Minced Free Fat Graft Versus Pedicle Fat Flap to Efface Orbital Rim Hollow in Lower Blepharoplasty.

Abstract

Lower eyelid fat flap repositioning during transconjunctival lower blepharoplasty (TCLB) is a widely accepted technique to prevent postoperative tear trough deformity. Its drawbacks include retraction, limited volume, trans-cutaneous fixation, and a complex insertion technique. The minced lower eyelid fat graft was introduced to overcome these drawbacks. The aim of this study is to compare the outcomes of pre-periosteal pedicle fat flap vs. minced free fat graft in TCLB. Participants with the pedicle fat flap (Group A) procedure from April 2019 to April 2020 and the minced free fat graft (Group B) from May 2020 to May 2021 with at least 6 months of follow-up were included. Subjective (pain, infra-orbital numbness) and objective (chemosis, residual skin wrinkles, hyperpigmentation, tear trough deformity, bumps) postoperative outcomes, satisfaction (visual analogue scale score) at the last follow-up, and re-operation rates were compared. There were 142 participants (94% women) with a mean age of 48.4 years (range: 21-71) and a follow-up of 8.2 months (range: 6-36). There were 73 participants in Group A and 69 in Group B with no significant difference in terms of age (p = 0.6), sex (p = 0.7) or follow-up (p = 0.3). In addition to TCLB, Group A and B had simultaneous upper eyelid and eyebrow procedures (53% vs. 49%, p = 0.2), lateral canthal plication (77% vs. 83%, p = 0.4), and pinch skin excision (82% vs. 88%, p = 0.3). Group A and B were not significantly different in terms of postoperative numbness (6.8% vs. 1.4%, p = 0.2), chemosis (11% vs. 10%, p = 1), skin wrinkles (12.3% vs. 8.7%, p = 0.5), hyperpigmentation (1.4% in both groups), bumps (2.7% vs. 7.2%, p = 0.2), tear trough deformity (0.0 % in both groups), satisfaction score (97.7% vs. 98.1%, p = 0.4), and re-operation rate (12.3% vs. 5.8%, p = 0.2). The desired aim of fat redistribution in TCLB seems to be equivalently achievable by either minced fat graft or pedicle fat flap technique.