Improvement in dark circles after transconjunctival fat removal with simultaneous autologous fat grafting versus transconjunctival fat repositioning

Background This study compared the improvement in lower eyelid dark circles after two surgical techniques: transconjunctival fat removal with simultaneous autologous fat grafting to the tear trough and premaxillary area, and transconjunctival fat repositioning.Methods Patients were retrospectively reviewed in two groups. Group 1 underwent transconjunctival fat removal with simultaneous autologous fat grafting, and group 2 underwent transconjunctival fat repositioning (52 patients, 104 eyes per group). Improvement in dark circles was quantified using the Orbital Gray Scale. The brightness difference was normalized to the brightest point on the same line, and generalized estimating equations were used to analyze both eyes of each patient together.Results Dark circles improved significantly after surgery in both groups (P<0.001). Lower eyelid brightness difference, the measure of dark circle severity used in this study, did not differ significantly between groups before surgery (P=0.203) but was lower in group 1 afterward (P<0.001). Improvement in dark circles was also greater in group 1 than in group 2 (P<0.001).Conclusions Transconjunctival fat removal with simultaneous autologous fat grafting produced a greater reduction in lower eyelid brightness difference than transconjunctival fat repositioning. Blinded clinical assessment using the Barton grade showed the same between-group difference. Longer follow-up is needed to determine whether this difference persists, along with independent, repeated brightness measurements by multiple observers.