Background: Aging in the lower eyelids creates bags under the eyes from the protruding orbital fat, and periorbital wrinkles. Therefore, lower blepharoplasty should be combined with a skin tightening procedure to enhance the results.
Objective: To compare the effects between lower blepharoplasty combined with an insulated microneedle radiofrequency (RF) device and lower blepharoplasty alone.
Methods: Twelve Asian (24 eyes) patients with baggy eyelids were included. One eye per patient was randomized for lower blepharoplasty combined with insulated microneedle RF devices (RF group), and the other eye for lower blepharoplasty alone (LB group). All patients underwent transconjunctival lower blepharoplasty with fat transposition and orbicularis oculi suspension. The primary outcome was the difference between both groups on the five-point Wrinkle Assessment Scale (WAS), assessed at baseline and at 2 months post-surgery. The secondary outcome was patient satisfaction using the Global Aesthetic Improvement Scale (GAIS).
Results: The WAS improvements were 75.0% (9/12 eyes) and 58.3% (7/12 eyes) in the RF and LB groups, respectively. The GAIS showed high patient satisfaction in both groups, with an average of 4.12 (3-5) in the RF group and 4.0 (2-5) in the LB group (p=0.157). There was no difference in the postoperative inflammation between both eyes at 1 week; and no decrease in the WAS score at 2 months or any adverse effects at 6 months were observed.
Conclusion: Wrinkle improvement was observed post-lower blepharoplasty with or without microneedle RF treatment. The insulated microneedle RF device proved safe when performed concurrently with lower blepharoplasty.

Keywords: blepharoplasty, cosmetic techniques, needles, radiofrequency therapy, randomized controlled trial, skin aging

1. McCann JD, Pariseau B. Lower eyelid and midface rejuvenation. Facial Plast Surg 2013;29:273-80.
   
2. Hidalgo DA. An integrated approach to lower blepharoplasty. Plast Reconstr Surg 2011;127:386-95.
   
3. Carter SR, Seiff SR, Choo PH, Vallabhanath P. Lower eyelid CO(2) laser rejuvenation: a randomized, prospective clinical study. Ophthalmology 2001;108:437-41.
   
4. Manuskiatti W, Siriphukpong S, Varothai S, Wanitphakdeedecha R, Fitzpatrick RE. Effect of pulse width of a variable square pulse (VSP) erbium:YAG laser on the treatment outcome of periorbital wrinkles in Asians. Int J Dermatol 2010;49:200-6.
   
5. Greene RM, Green JB. Skin tightening technologies. Facial Plast Surg 2014;30:62-7.
   
6. Lee SJ, Kim JI, Yang YJ, Nam JH, Kim WS. Treatment of periorbital wrinkles with a novel fractional radiofrequency microneedle system in dark-skinned patients. Dermatol Surg 2015;41:615-22.
   
7. Calderhead RG, Goo BL, Lauro F, Gursoy D, Savant S, Wronski A. The clinical efficacy and safety of microneedling fractional radiofrequency in the treatment of facial wrinkles: a multicenter study with the INFINI system in 499 patients [Internet]. Goyang: Lutronic; c2013 [cited 2017 May 28].
   Available from: http://ayalasers.com/pdf/INFINI_WP_multicenter_ 499_cases_20130710.pdf.
8. Roberts TL 3rd, Yokoo KM. In pursuit of optimal periorbital rejuvenation: laser resurfacing with or without blepharoplasty and brow lift. Aesthet Surg J 1998;18:321-32.
   
9. Chan HH, Manstein D, Yu CS, Shek S, Kono T, Wei WI. The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians. Lasers Surg Med 2007;39:381-5.