Background: Traditional subciliary incision lower blepharoplasty (TSILB) is commonly used for improving aged lower eyelid. Fat grafting has been popularly performed to correct shortcomings of TSILB such as infraorbital hollowness and incomplete blending of lid-cheek junction (LCJ). LCJ has been known as an objective index to measure the aging of lower eyelid. However, there was no study on the changes of LCJ length and shape with complementary fat grafting.
Objective: This study aimed to evaluate the effect of complementary fat grafting by observing the changes in length and shape of the LCJ.
Methods: Between 2010 and 2016, the authors observed the change of LCJ in 33 patients who were followed-up for more than 3 months among patients who underwent TSILB alone (Group 1, G1) or TSILB combined with fat grafting (Group 2, G2). The fat graft was performed by sequential autologous fat injection method, having the concept of volumetric face lifting. The groups were further divided into subgroups G1p, G1n, G2p, and G2n according to positive (p) or negative (n) globe-to-skeletal rim relations. Suborbicularis oculi fat lifting and lateral retinacular canthopexy were mainly performed in patients who had negative vector.
Results: The length of LCJ in G2 decreased significantly compared to that of G1. There was no significant difference between G1p and G1n, and G2p and G2n. The shape of LCJ changed diversely from V-shape to flat shape and was more dramatic in G2 than in G1. In G1, superolateral shifting in lateral points of LCJ was a typical change, but in G2, superolateral shifting and vertical shifting of LCJ were more prominently occurred at medial and middle points of LCJ, which were mainly induced by fat grafting.
Conclusion: Complementary fat grafting showed better rejuvenation effect through further changes of LCJ in length (shortening) and shape (flattening) than that of TSILB alone.
Level of Evidence: IV

Keywords: fat grafting, lid-cheek junction, lower blepharoplasty, subciliary

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