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J Cosmet Med 2018; 2(1): 12-21

Published online June 30, 2018

https://doi.org/10.25056/JCM.2018.2.1.12

Complementary effect of fat grafting on traditional subciliary incisional lower blepharoplasty: estimated by the change of lid-cheek junction

Kyoungjin Kang, MD, PhD1 , Choongyee Chai, MS2

1Seoul Cosmetic Surgery Clinic, Busan, Rep. of Korea, 2Korean College of Cosmetic Surgery, Busan, Rep. of Korea

Correspondence to :
Kyoungjin Kang, E-mail: mdkjkang@hanmail.net, ORCID: https://orcid.org/0000-0002-9413-0273

Received: January 23, 2018; Revised: March 25, 2018; Accepted: March 28, 2018

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

  1. Jacqueline MU, Kitaguchi Y, Takahashi Y, Kakizaki H. Age-related eyelid changes. J Cosmet Med 2017;1:16-24.
    CrossRef
  2. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007;120:1367-76; discussion 1377.
    Pubmed CrossRef
  3. Kang KJ, Yang HH, Chai CY. Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty. J Cosmet Med 2017;1:30-8.
    CrossRef
  4. Mohadjer Y, Holds JB. Cosmetic lower eyelid blepharoplasty with fat repositioning via intra-SOOF dissection: surgical technique and initial outcomes. Ophthalmic Plast Reconstr Surg 2006;22:409-13.
    Pubmed CrossRef
  5. Trepsat F. Periorbital rejuvenation combining fat grafting and blepharoplasties. Aesthetic Plast Surg 2003;27:243-53.
    Pubmed CrossRef
  6. Morley AM, Malhotra R. Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery. Ophthalmic Plast Reconstr Surg 2011;27:69-73.
    Pubmed CrossRef
  7. Coleman SR. Facial augmentation with structural fat grafting. Clin Plast Surg 2006;33:567-77.
    Pubmed CrossRef
  8. Lam SM, Glasgold MJ, Glasgold RA. Complementary fat grafting. Philadelphia, PA: Lippincott, Williams & Wilkins Co.;2007. p. 58-77.
  9. Kang KJ. SAFI (sequential autologous fat injection). Seoul:Koonja Publishing Inc.; 2016. p. 71-6.
  10. Kang KJ. SAFI (sequential autologous fat injection). Seoul:Koonja Publishing Inc.; 2016. p. 223-31.
  11. Yaremchuk MJ. Restoring palpebral fissure shape after previous lower blepharoplasty. Plast Reconstr Surg 2003;111:441-50; discussion 451-2.
    Pubmed CrossRef
  12. Hester TR Jr, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging:maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg 2000;105:393-406; discussion 407-8.
    Pubmed CrossRef
  13. Tonnard PL, Verpaele AM, Zeltzer AA. Augmentation blepharoplasty:a review of 500 consecutive patients. Aesthet Surg J 2013;33:341-52.
    Pubmed CrossRef
  14. Lupo F, Ioppolo L, Pino D, Meduri A, d’Alcontres FS, R Colonna M, et al. Lipograft in cicatricial ectropion. Ann Ital Chir 2016;87:466-9.
    Pubmed
  15. Matros E, Momoh A, Yaremchuk MJ. The aging midfacial skeleton: implications for rejuvenation and reconstruction using implants. Facial Plast Surg 2009;25:252-9.
    Pubmed CrossRef
  16. Flowers RS. Augmentation maxilloplasty. In: Terino EO, Flowers RS, editors. The art of alloplastic facial contouring. St. Louis: Mosby Co.; 2000. p. 129-50.

Article

Original Article

J Cosmet Med 2018; 2(1): 12-21

Published online June 30, 2018 https://doi.org/10.25056/JCM.2018.2.1.12

Copyright © Korean Society of Korean Cosmetic Surgery.

Complementary effect of fat grafting on traditional subciliary incisional lower blepharoplasty: estimated by the change of lid-cheek junction

Kyoungjin Kang, MD, PhD1 , Choongyee Chai, MS2

1Seoul Cosmetic Surgery Clinic, Busan, Rep. of Korea, 2Korean College of Cosmetic Surgery, Busan, Rep. of Korea

Correspondence to:Kyoungjin Kang, E-mail: mdkjkang@hanmail.net, ORCID: https://orcid.org/0000-0002-9413-0273

Received: January 23, 2018; Revised: March 25, 2018; Accepted: March 28, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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

References

  1. Jacqueline MU, Kitaguchi Y, Takahashi Y, Kakizaki H. Age-related eyelid changes. J Cosmet Med 2017;1:16-24.
    CrossRef
  2. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007;120:1367-76; discussion 1377.
    Pubmed CrossRef
  3. Kang KJ, Yang HH, Chai CY. Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty. J Cosmet Med 2017;1:30-8.
    CrossRef
  4. Mohadjer Y, Holds JB. Cosmetic lower eyelid blepharoplasty with fat repositioning via intra-SOOF dissection: surgical technique and initial outcomes. Ophthalmic Plast Reconstr Surg 2006;22:409-13.
    Pubmed CrossRef
  5. Trepsat F. Periorbital rejuvenation combining fat grafting and blepharoplasties. Aesthetic Plast Surg 2003;27:243-53.
    Pubmed CrossRef
  6. Morley AM, Malhotra R. Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery. Ophthalmic Plast Reconstr Surg 2011;27:69-73.
    Pubmed CrossRef
  7. Coleman SR. Facial augmentation with structural fat grafting. Clin Plast Surg 2006;33:567-77.
    Pubmed CrossRef
  8. Lam SM, Glasgold MJ, Glasgold RA. Complementary fat grafting. Philadelphia, PA: Lippincott, Williams & Wilkins Co.;2007. p. 58-77.
  9. Kang KJ. SAFI (sequential autologous fat injection). Seoul:Koonja Publishing Inc.; 2016. p. 71-6.
  10. Kang KJ. SAFI (sequential autologous fat injection). Seoul:Koonja Publishing Inc.; 2016. p. 223-31.
  11. Yaremchuk MJ. Restoring palpebral fissure shape after previous lower blepharoplasty. Plast Reconstr Surg 2003;111:441-50; discussion 451-2.
    Pubmed CrossRef
  12. Hester TR Jr, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging:maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg 2000;105:393-406; discussion 407-8.
    Pubmed CrossRef
  13. Tonnard PL, Verpaele AM, Zeltzer AA. Augmentation blepharoplasty:a review of 500 consecutive patients. Aesthet Surg J 2013;33:341-52.
    Pubmed CrossRef
  14. Lupo F, Ioppolo L, Pino D, Meduri A, d’Alcontres FS, R Colonna M, et al. Lipograft in cicatricial ectropion. Ann Ital Chir 2016;87:466-9.
    Pubmed
  15. Matros E, Momoh A, Yaremchuk MJ. The aging midfacial skeleton: implications for rejuvenation and reconstruction using implants. Facial Plast Surg 2009;25:252-9.
    Pubmed CrossRef
  16. Flowers RS. Augmentation maxilloplasty. In: Terino EO, Flowers RS, editors. The art of alloplastic facial contouring. St. Louis: Mosby Co.; 2000. p. 129-50.

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