Correcting Sunken Eyelid by Orbital Fat Transposition During Subbrow Lift

Aesthetic Plast Surg. 2025 Aug 29. doi: 10.1007/s00266-025-05150-x. Online ahead of print.

ABSTRACT

BACKGROUND: The subbrow approach is reportedly more effective than upper blepharoplasty for improving lateral hooding. Additionally, it allows for the removal of thick periorbital fat while simultaneously tightening weakened and sagging orbicularis oculi muscles. This study introduces a method for repositioning and redistributing the medial fat pad to the central area, restoring fullness in the central area, and improving medial upper eyelid bulging.

METHODS: From January 2023 to June 2024, 74 patients were followed up preoperatively, and 1 week and 6 months postoperatively. The medial and central fat pads were graded based on the bulging degree using a scale from 0 to 3 (0 for depressed, 1 for flat, 2 for mildly protruded, and 3 for markedly protruded).

RESULTS: The medial fat pad grade had a reduction of 0.8, which indicated improvement in nasal bulging, whereas the central fat pad grade increased by 1.3, which indicated improvement in sunken areas and fullness restoration. These results are also reflected in the Likert scale scores; 25 and 33 patients reported “much improved” and “markedly improved,” respectively, with a 78% satisfaction rate. Just as the superficial musculoaponeurotic system is repositioned in a superolateral direction during a facelift, moving the orbital fat superolaterally during subbrow lift blepharoplasty can yield better results.

CONCLUSION: This procedure is considered a highly effective because the changes are distinctly noticeable to the patients themselves.

LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:40879736 | DOI:10.1007/s00266-025-05150-x