Minced Free Fat Graft Versus Pedicle Fat Flap to Efface Orbital Rim Hollow in Lower Blepharoplasty
Nasser Karimi1 *, Mohsen Bahmani Kashkouli1 , Hossein Ghahvehchian1
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abstract: Purpose: Lower eyelid fat flap repositioning during transconjunctival lower blepharoplasty
(TCLB) is a widely accepted technique to prevent postoperative tear trough deformity. Its
retraction, limited volume, trans-cutaneous fixation, and complex technique of insertion are the
drawbacks. Minced lower eyelid fat graft was introduced to overcome the drawbacks. The aim of
this study is to compare the outcomes of pre-periosteal pedicle fat flap vs. minced free fat graft in
TCLB.
Methods: Methods: Participants with pedicle fat flap from April 2019 to April 2020 and minced free fat
graft from May 2020 to May 2021 with at least 6 months follow up were included. Subjective
(pain, infra-orbital numbness) and objective (chemosis, residual skin wrinkles,
hyperpigmentation, tear trough deformity, bumps) postoperative outcomes as well as satisfaction
(visual analogue scale score) at the last follow up and re-operation rates were compared.
Results: Results: There were 142 participants (94% women) with the mean age of 48.4 years (Range: 21-
71) and follow up of 8.2 months (Range: 6-36). There were 73 participants in the group A and 69
in the group B with no significant difference in terms of age (p = 0.6), sex (p = 0.7) and 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 = 0.21), chemosis (11 vs 10%, p = 1), skin wrinkles
(12.3 vs 8.7%, p = 0.59), hyperpigmentation (1.4% in both), bumps (2.7 vs 7.2%, p = 0.2), tear
trough deformity (0.0 % in both), satisfaction score (97.7 vs 98.1%, p = 0.4), and re-operation
rate (12.3 vs 5.8%, p = 0.25).
Conclusion: Conclusion: The pursued aims of fat redistribution in TCLB seem to be equivalently achievable
by either minced fat graft or pedicle fat flap technique.
