A Combination of Three-Step Lower Blepharoplasty to Correct Four Types of Lower Eyelid Deformities in Asian People

Complete Orbital Septum Release and Full Integration and Repositioning of Orbital Septal Fat Tissue (F.I.R.S.T.) in Transconjunctival Lower Blepharoplasty

BACKGROUND

After the introduction of orbital septal fat release and reposition in transconjunctival lower blepharoplasty (TCLB), few studies have addressed the thorough release of orbital fat tissue to adequately augment the tear trough and midface concavity. Additionally, limited literature exists regarding residual or recurrent eye bags and corresponding preventive measures after fat release and repositioning in TCLB.

METHODS

From December of 2021 to May of 2023, 105 patients were treated with the full integration and repositioning of orbital septal fat tissue (F.I.R.S.T.) technique in TCLB. This study observed the effectiveness of correcting tear trough deformity (TTD) and midcheek depression using the technique, and we have documented all complications, especially the residual eye bags.

RESULTS

This mean age was 34 years (range: 19-54 years) with a mean follow-up of 13 months (range: 3-17 months). The average operation duration was 55 ± 7.1 minutes (range: 45-89 mins). Among the cases, 70 eyes (33.33%) had Grade I TTD, 92 eyes (43.8%) had Grade II TTD, and 48 eyes (22.9%) had Grade III TTD. Successful correction was achieved in all Grade I cases, with 75 eyes (81.52%) improving to Grade 0 among Grade II cases. For Grade III cases, 28 eyes (58.33%) improved to Grade 0. Our technique has significantly improved the tear trough area for nearly 2 mm. Only one patient complained about fat residual and no patients had relapses.

CONCLUSIONS

The F.I.R.S.T. technique effectively prevents fat residual in the lower eyelid area and provides favorable postoperative filling effects in the tear trough and midcheek region.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Efficacy and Safety of Stromal Vascular Fraction in the Treatment of Tear Trough Deformity: A Systematic Review and Meta-Analysis

BACKGROUND

Stromal vascular fraction (SVF) grafting is an effective method to correct tear trough deformity. Nevertheless, the quantitative data of satisfactory rate and complications of SVF compared with normal autologous fat graft (AFG) remain unemployed. The aim of this meta-analysis was to synthesize the current quantitative data on satisfactory rate and complications of tear trough deformity correction with SVF and normal AFG.

METHODS

A comprehensive literature search was performed in PubMed, Web of Science, and the Cochrane library. All studies evaluating AFG or SVF in the treatment of tear through deformity were included. Then, data were extracted and analyzed using single-arm meta-analysis. The satisfactory rates and complication rates of different techniques were compared. A subgroup analysis was performed according to the specific AFG techniques used.

RESULTS

A total of 20 literatures comprising 2372 participants were included. Five studied SVF and 15 studied other AFGs. The pooled satisfaction rate of AFG was 94.9% (95% CI 92.2-97.7%, I2 = 65%). A total of 154 cases reported complications. Most common complications were skin winkle 26 cases (16.88%), fat under-correction 24 cases (15.58%) and subcutaneous induration 18 cases (11.69%) (Table 2). The pooled complication rate of AFG was 10.1% (95% CI 4.6-15.6%, I2 = 92%). The pooled complication rate of SVF was 1.5% (95% CI 0-15.6%, I2 = 0%).

CONCLUSION

Satisfaction rates for both normal AFG and SVF were generally high, with mostly minor complications observed. The incidence of complications with SVF was lower than with normal AFG, and severe complications were rare.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

AI Prediction for Post-Lower Blepharoplasty Age Reduction

BACKGROUND

Aesthetic standards vary and are subjective; artificial intelligence (AI), which is currently seeing a boom in interest, has the potential to provide objective assessment.

OBJECTIVES

The aim of this study was to provide a relatively objective assessment of the aesthetic outcomes of lower blepharoplasty-related surgeries, thereby enhancing the decision-making process and understanding of the surgical results.

METHODS

This study included 150 patients who had undergone lower blepharoplasty-related surgeries. Analysis was performed with FaceAge software, created by the authors' research team, which included 4 publicly available age estimation convolution neural network (CNN) models: Amazon Rekognition (Seattle, WA), Microsoft Azure Face (Redmond, WA), Face++ Detect (Beijing, China), and Inferdo face detection (New York, NY). This application was used to compare the subjects' real age and their age as estimated by the 4 CNNs. In addition, this application was used to estimate patient age based on preoperative and postoperative images of all 150 patients and to evaluate the effect of lower blepharoplasty.

RESULTS

In terms of accuracy in age prediction, all CNN models exhibited a certain degree of accuracy. For all 150 patients undergoing lower blepharoplasty-related surgeries, these surgeries resulted in about 2 years of rejuvenation with a statistically significant difference; for the sex difference, men had more age reduction than women also with a statistically significant difference; quadrilateral blepharoplasty showed the most significant antiaging effect.

CONCLUSIONS

By using deep-learning models, lower blepharoplasty-related surgeries actually had an effect on perceived age reduction. Deep learning models have the potential to provide quantitative evidence for the rejuvenating effects of blepharoplasty and other cosmetic surgeries.

Complications of Fat Grafting and Repositioning for Correction of Lower Eyelid Pouch With Tear Trough Deformity or Lid-Cheek Junction: A Systematic Review

BACKGROUND

Fat grafting and repositioning may serve as a convenient, economical, and effective surgical method for correcting lower eyelid pouch with a tear trough deformity or lid-cheek junction. However, comprehensive systematic reviews and meta-analyses investigating the complications associated with this technique are lacking.

OBJECTIVE

This study aimed to summarize and gather data on complications related to fat grafting and repositioning for the correction of tear trough deformity or lid-cheek junction in lower eyelid blepharoplasty.

METHODS

A thorough search was performed across multiple databases including PubMed, Cochrane, Embase, ProQuest, Ovid, Scopus, and Web of Science. Specific inclusion and exclusion criteria were applied to screen the articles. The occurrence of complications was analyzed using a random-effects model.

RESULTS

A total of 33 studies involving 4671 patients met the criteria for systematic evaluation and were included in this meta-analysis. The overall complication rates were 0.112 (95% confidence interval [CI]: 0.060-0.177) for total complications, 0.062 (95% CI: 0.003-0.172) for unsatisfactory correction or contour irregularity, 0.062 (95% CI: 0.009-0.151) for hematoma, swelling (not specified as bulbar conjunctiva), ecchymosis, or oozing of blood, and 0.024 (95% CI: 0.013-0.038) for reoperation.

CONCLUSIONS

Fat grafting and repositioning for correcting a lower eyelid pouch with tear trough deformity or lid-cheek junction was associated with high rates of complications. Therefore, it is crucial to closely monitor the rates of unsatisfactory correction or contour irregularity, hematoma, swelling (not specified as bulbar conjunctiva), ecchymosis, or oozing of blood, and reoperation. In addition, effective communication with patients should be prioritized.