Objective Assessment of Combined Orbital Fat Repositioning and Fat Grafting in Upper Eyelid Hollowing

Background: Upper eyelid hollowing is a common manifestation of periorbital aging caused by soft-tissue atrophy and loss of orbital fat volume. Although various corrective techniques have been described, outcome assessment remains largely subjective. High-resolution ultrasonography may provide an objective and quantitative method for evaluating postoperative soft-tissue changes. Objective: The present study aimed to evaluate the effectiveness and stability of combined orbital fat repositioning and microfragmented autologous fat grafting for the correction of moderate upper eyelid hollowing, using high-resolution ultrasonography as an objective assessment tool. Methods: A prospective study was conducted in 35 female patients (70 upper eyelids), aged 40–65 years, with moderate upper eyelid hollowing (Park grade II). All patients underwent combined orbital fat pad repositioning with supplemental microfragmented autologous fat grafting. High-resolution ultrasonography was performed preoperatively and at 1, 3, and 6 months postoperatively to measure the space anterior to the upper eyelid skin (D1) and upper eyelid thickness (D2). Clinical outcomes and patient satisfaction were also evaluated. Results: he mean preoperative hollowing depth was 5.88 ± 0.85 mm, and the mean grafted fat volume was 1.09 ± 0.29 mL. Postoperative ultrasonography demonstrated a significant decrease in D1 and a significant increase in D2 at all postoperative time points compared with baseline (all p < 0.05). No statistically significant differences were observed between the 3- and 6-month follow-up periods (p > 0.05), indicating stabilization of outcomes after 3 months. Overall patient satisfaction was 97.14%. No major complications were observed. Conclusion: Combined orbital fat repositioning and microfragmented autologous fat grafting is a safe and effective technique for correcting moderate upper eyelid hollowing. High-resolution ultrasonography provides an objective, reproducible, and clinically applicable method for postoperative outcome assessment.