Rejuvenation of the Lower Eyelid and Midface with Deep Nasolabial Fat Lift in East Asians

Abstract

Background: Correcting infraorbital hollowness is an important procedure for midface rejuvenation. Sub–orbicularis oculi fat lift is a commonly used method. However, adipose tissue, which has been thought of as sub–orbicularis oculi fat, has recently been controversial. The objective of this study was to introduce a method of midface rejuvenation using deep nasolabial fat lift (MRDN) by means of lower blepharoplasty and to compare surgical outcomes between MRDN and lower blepharoplasty with fat transposition (LBF). Methods: The medical records of patients who had undergone midface rejuvenation with lower blepharoplasty between 2013 and 2020 were retrospectively reviewed. Questionnaires, digital photographs, and charts were used to evaluate the surgical outcomes and complications. The degree of aging was graded as mild, moderate, or severe. LBF and MRDN were used for mild and severe grades, respectively. For the moderate grade, the preferred surgical method of the two methods was selected and surgical outcomes were compared. The MRDN technique included LBF. Results: Postoperative satisfaction was significantly higher (P < 0.001), recurrence rate for tear trough (P = 0.046) and fat bulging (P = 0.005) was significantly lower, duration of swelling (P < 0.001) was significantly longer, and incidence of chemosis (P = 0.024) was significantly higher in the MRDN group than in the LBF group. Regarding lid malposition, transient retraction was higher in the LBF group, whereas cicatricial ectropion was higher in the MRDN group; however, these differences were not significant. Conclusion: MRDN is associated with higher patient satisfaction and surgical longevity without serious complications than LBF. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.