Overlapping Pretarsal and Preseptal Orbicularis Oculi Muscles Enhance Pretarsal Fullness: Personalized Lower Eyelid Blepharoplasty for Asian Patients.

[BACKGROUND] Aging of the lower eyelid region can lead to changes, such as those in the shape and function of the eye, significantly impacting the quality of life of patients. Surgery can rejuvenate the lower eyelid; however, it requires improvement, especially among Asian patients. This study aimed to explore approaches for improving the surgical technique of lower eyelid rejuvenation and clarify the necessity of tear trough deformity correction among Asian patients.

[METHODS] Patients who underwent modified lower blepharoplasty from January 2019 to December 2021 at the Shanghai Ninth People's Hospital were reviewed. All patients completed photographic and aesthetic evaluations before surgery and were followed up for 12 months postoperatively.

[RESULTS] Among 189 patients who underwent modified lower blepharoplasty, which included overlapping pretarsal and preseptal orbicularis oculi muscles (OOMs) and the tear trough deformity correction, fat transposition was performed in 18 patients (9.52%) with a visualized tear trough after the pull test. During the 6-month follow-up, 137 patients had excellent outcomes. No patient had infections, permanent diplopia, hypertrophic scarring, and permanent eyelid retraction or ectropion. Three patients with skin hematoma were relieved in three months. Seven patients showed mild ectropion, which was relieved with massage within six months. Twelve patients underwent re-operation, and 16 patients received filler augmentation.

[CONCLUSIONS] The modified lower blepharoplasty improved periorbital contouring, thereby rejuvenating pretarsal fullness. The findings of this study could help develop strategies for enhancing lower eyelid rejuvenation.

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