Effectiveness of concomitant blepharoplasty and midface lipofilling

Background. Age-related periorbital changes are multifactorial. Periorbital aging affects all anatomical structures of this area including facial skeleton with subsequent atrophy of muscles and ligaments, fat packets, and skin texture changes. Therefore, correction of age-related changes in this area requires complex approach. At the same time, it is necessary to preserve periorbital structures. Combination of techniques, for example, simultaneous blepharoplasty and facial lipofilling, is effective to achieve appropriate results. Material and methods. We performed 42 interventions in women including upper and lower blepharoplasty with midface lipofilling. The indications for this intervention were excess skin of the upper and lower eyelids, prolapse of fatty bags of the upper and lower eyelids, deepening of nasolabial grooves, insufficient midface volume, deepening of nasolacrimal folds. Prior to surgery, we measured necessary volume of autologous fat for lipofilling according to original method. The first stage implied autologous adipose tissue harvesting, the second stage — upper blepharoplasty, the third stage — midface lipofilling, final stage — lower blepharoplasty. Results. The patients were followed-up for 1-1.5 years. Additional lipofilling for midface replenishment was not necessary in 70% of cases. Most often, volume replenishment was necessary in the upper eyelids, sub-brow and temporal areas. When comparing preservation of autologous fat volume in different zones, we found the advantages of infraorbital-buccal region: the greatest thickness of subcutaneous fat layer, dense network of perforators, distant location of bone and muscle from the fat layer, voluminous fat packet as a favorable environment for fat engraftment. Conclusion. Our own experience of concomitant blepharoplasty and midface lipofilling shows the effectiveness of this technique and satisfactory treatment outcomes. This technique is advisable in patients with excess skin of the upper and lower eyelids, prolapsed fatty tissues of the upper and lower eyelids, deepening of nasolacrimal grooves, lack of midface volume and deepening of nasolabial folds. Check-lifting technique is preferable for lack of midface volume, malar fat pad atrophy and presence of scallops. In other cases, midface lipofilling will be an excellent addition to blepharoplasty with minimal tissue trauma, preservation of periorbital structures, regenerative effect and excellent clinical results.