title: Augmentation blepharoplasty: a review of 500 consecutive patients.
abstract: BACKGROUND
  Volume loss in the upper and lower eyelids and in the malar area is now considered a major component of periorbital aging. As classical resection blepharoplasty does not address this loss, filling procedures are becoming increasingly common.
  
  
  OBJECTIVE
  The authors present their experience with periorbital fat grafting in conjunction with routine blepharoplasty to address periorbital aging.
  
  
  METHODS
  Outcomes were retrospectively reviewed for 500 consecutive patients who underwent blepharoplasty in conjunction with the authors' periorbital augmentation technique from January 2008 to September 2011. The augmentation technique was a fine particle fat (microfat) grafting procedure that involved the use of small-diameter cannulae for transfer of autologous fat to the medial part of the upper eyelid, the orbitomalar groove, and the malar area.
  
  
  RESULTS
  Clinical evaluation and review of patient photographs revealed favorable, natural-looking, and long-lasting improvement of the treated areas. Shortcomings of classical resection blepharoplasty, such as hollowing of the upper eyelids, incomplete blending of the eyelid-cheek junction, and persistent deflation of the midface, were avoided; the full and crisp aspect of the upper and lower eyelids seen at a younger age was regained; and the technique was not associated with the complications seen in an earlier patient series. No major complications occurred. Minor complications included bruising and swelling.
  
  
  CONCLUSIONS
  Augmentation of the upper and lower eyelids through microfat grafting can be a useful alternative to existing blepharoplasty techniques. This study documents very natural and pleasing results that avoid the shortcomings of classical resection. Microfat grafting appears to be a valuable and safe alternative to complicated, difficult, and potentially dangerous eyelid and midface rejuvenation techniques.
authors.affiliation: Department of Plastic Surgery, Gent University Hospital, Gent, Belgium. patrick@coupurecentrum.be
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Tonnard
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Verpaele
authors.forename: Assaf A
authors.initials: AA
authors.lastname: Zeltzer
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D000375:Aging; D019882:Blepharoplasty / Q000009:adverse effects / Q000379:methods*; D003357:Cosmetic Techniques / Q000009:adverse effects; D005143:Eyelids / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D012060:Rejuvenation; D012189:Retrospective Studies; D015595:Skin Aging; D014182:Transplantation, Autologous; D016896:Treatment Outcome