Application of Autologous Fat Grafting Combined With Orbital Fat Flap Transposition for the Correction of Mild to Moderate Upper Eyelid Hollowing in Double Eyelid Surgery: A 3-Arm Retrospective Controlled Study

OBJECTIVE: To evaluate and compare the clinical efficacy of orbital fat flap transposition combined with autologous fat grafting, hyaluronic acid injection, or orbital fat flap transposition alone in the correction of mild to moderate upper eyelid hollowing during double eyelid surgery. METHODS: A total of 135 patients with single eyelids and mild to moderate upper eyelid hollowing, treated between March 2022 and June 2025, were retrospectively enrolled. Patients were allocated into 3 groups according to the surgical approach: group A: orbital fat flap transposition alone (n=47); group B: orbital fat flap transposition combined with autologous fat grafting (n=46); and group C: orbital fat flap transposition combined with hyaluronic acid injection (n=42). Postoperative improvement in upper eyelid hollowing depth and patient satisfaction were compared among the 3 groups. RESULTS: In the early postoperative period (1-3 mo), group B showed the greatest improvement in hollowing depth (8.07±0.79 mm), significantly better than group C (7.63±0.67 mm) and group A (5.45±0.46 mm) (P<0.01). During the mid- to long-term follow-up (9-12 mo), the improvement in group A (4.87±0.56 mm) was significantly lower than in group B (7.63±0.67 mm) and group C (6.67±1.45 mm). CONCLUSION: For patients undergoing double eyelid surgery with mild to moderate upper eyelid hollowing, orbital fat flap transposition combined with autologous fat grafting offers superior correction efficacy, greater stability, and higher patient satisfaction compared with hyaluronic acid injection or fat flap transposition alone. This combination may therefore represent a more optimal surgical approach. Notably, some patients in group C reported a localized "water-absorbing swelling sensation," which negatively affected overall satisfaction. In contrast, group B consistently achieved higher satisfaction scores, indicating better biocompatibility and long-term outcome stability.