Refined trimming of orbital fat in transconjunctival lower blepharoplasty: A retrospective cohort study on clinical outcomes and aesthetic assessment

Herniated orbital fat and tear trough deformity are key manifestations of periorbital aging. While transconjunctival lower blepharoplasty effectively addresses these concerns, contemporary fat-preserving techniques can lead to midfacial overfilling when orbital fat volume is excessive. This study evaluates a surgical technique incorporating precise orbital fat trimming to prevent overcorrection and achieve optimal aesthetic outcomes. A retrospective cohort study was conducted on 97 patients who underwent transconjunctival lower blepharoplasty with refined orbital fat trimming between July 2019 and July 2023. All procedures were performed by a single surgeon. Outcome measures included operative time, postoperative complications, patient-reported satisfaction using the validated FACE-Q Satisfaction with Eyes scale (scored 1-4), Barton grade improvement, and objective aesthetic assessment by 2 independent blinded surgeons using a novel 5-point Likert scale evaluating 4 domains: orbital fat contour, lid-cheek junction, overall improvement, and symmetry. The mean age was 37.73 ± 4.88 years with mean follow-up of 8.2 ± 2.1 months. Mean operative time was 56.34 ± 5.61 minutes. No major complications occurred. Minor complications included transient lower eyelid swelling (100%, resolving within 8 weeks), mild chemosis (2.1%, resolving within 2 weeks), mid-facial skin numbness (3.1%, resolving within 3 weeks), and mild bleeding (7.2%, ≤0.5 mL). Patient satisfaction was high (mean FACE-Q score 3.63 ± 0.52), with 67.01% "very satisfied", and 29.90% "somewhat satisfied." Objective aesthetic assessment showed significant improvement (mean score 4.2 ± 0.6) with excellent inter-rater reliability (intraclass correlation coefficient = 0.89). All cases demonstrated resolution of fat herniation and significant tear trough improvement without overfilling. Refined trimming of orbital fat in transconjunctival lower blepharoplasty effectively addresses both fat herniation and tear trough deformity while preventing midfacial overfilling. This technique represents an advance in personalized lower blepharoplasty, demonstrating high safety, efficacy, and patient satisfaction through standardized outcome measures.