Unexpected Oil Cyst Formation Following Lower Blepharoplasty Despite Adinizer-Assisted Microfat Grafting: Limitations of Fat Particle Size Reduction

Oil cyst formation after periocular autologous fat grafting is infrequently reported but represents a clinically relevant complication because it may present as a palpable mass and mimic other eyelid lesions. Various fat-processing techniques, including mechanical microfragmentation, have been introduced to reduce fat particle size and improve graft survival. However, whether fat particle size reduction alone can prevent oil cyst formation in the periocular region remains unclear. We report 2 patients who developed periocular oil cysts following lower blepharoplasty with autologous fat grafting performed using a standardized protocol that included Adinizer-assisted mechanical microfragmentation and small-volume injection. A 47-year-old woman with diabetes mellitus developed a fluctuant lower eyelid nodule 3 months postoperatively, which required repeated aspiration but eventually resolved without surgical excision. A 55-year-old woman with hypertension developed a similar lesion 4 months postoperatively that resolved after a single aspiration. These cases demonstrate that periocular oil cysts may occur despite optimized fat-processing techniques, including Adinizer-assisted microfragmentation, suggesting that reduction of fat particle size alone may not be sufficient to prevent this complication. These findings suggest that recipient-site characteristics, surgical factors, and systemic vascular comorbidities may play a more important role than fat-processing methods in determining graft survival.