Reflections on Aging Series: Multiple Factors Influencing Lower Blepharoplasty Procedure Selection in an East Asian Population

Abstract Background The lower eyelid, because of its unique functional and anatomical characteristics, is highly susceptible to early signs of aging. There is overlap in the manifestation of age-specific senescent features across age groups, with progressive step. Objectives The authors of this study aim to identify the key features and treatment approaches for lower eyelid aging in East Asian patients by conducting a retrospective analysis of clinical presentations and treatment outcomes across different age groups. It also identifies which factors are more important to East Asians in recent decades. Methods Outpatients dissatisfied with their lower eyelid appearance were included. Data were collected on lower eyelid aging characteristics, including lower eyelid bags, tear trough deformities, wrinkles, and midface aging changes. Treatment experiences were documented based on these clinical presentations. Results A total of 439 patients were analyzed, comprising 61 males and 378 females, aged 20 to over 50 years, from 2014 to 2022. For younger patients exhibiting early signs of eyelid aging, treatment focused on dynamic periorbital wrinkles, protruding eye bags, and tear trough deformities. Patients with static wrinkles and lower eyelid laxity benefited from loose skin excision and septum fat resetting for restoring the volumetric displacement. Midface lifting was recommended for those with facial laxity to achieve optimal results. The percentage of orbital fat resetting surgeries of all surgeries was 53%. Among these patients, 10% expressed dissatisfaction, 58% were satisfied with the results, and 32% were very satisfied with the treatment outcome. Conclusions East Asians today are more concerned with the smoothness and fullness of the lower eyelid area, and the importance of orbital fat repositioning is emphasized across age groups. The proportional increase of transconjunctival blepharoplasty after age 40 is because of the enhanced facial care. Level of Evidence: 3 (Therapeutic)