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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Fat management in upper blepharoplasty: Addition or subtraction blepharoplasties, how and when
Giovanni Miotti, Jacopo Di Filippo, Martina Grando, Carlo Salati, Pier Camillo Parodi, Leopoldo Spadea, Caterina Gagliano, Mutali Musa, Marco Zeppieri
Giovanni Miotti, Jacopo Di Filippo, Pier Camillo Parodi, Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
Martina Grando, Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento 33078, Italy
Carlo Salati, Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Leopoldo Spadea, Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
Caterina Gagliano, Department of Medicine and Surgery, University of Enna "Kore", Enna 94100, Italy
Caterina Gagliano, Eye Clinic, Catania University San Marco Hospital, Catania 95121, Italy
Mutali Musa, Department of Optometry, University of Benin, Benin 3000283, Nigeria
Mutali Musa, Department of Ophthalmology, Centre for Sight Africa, Nkpor, Onitsha 434112, Niger
Author contributions: Miotti G, Di Filippo J and Zeppieri M wrote the outline; Miotti G and Di Filippo J did the research and writing of the manuscript; Grando M, Salati C, Parodi PC, Spadea L, Gagliano C, Musa M, and Zeppieri M assisted in the writing of the draft and final paper; Zeppieri M was responsible for the conception and design of the study and completed the English and scientific editing; Miotti G, Di Filippo J, Grando M, Salati C, Parodi PC, Spadea L, Gagliano C, Musa M, and Zeppieri M assisted in the editing, making critical revisions of the manuscript and viewing all versions of the manuscript. All authors provided the final approval of the article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Marco Zeppieri, MD, PhD, Doctor, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy.
markzeppieri@hotmail.com
Received: January 22, 2024
Revised: February 12, 2024
Accepted: April 11, 2024
Published online: June 6, 2024
Processing time: 128 Days and 1.9 Hours
BACKGROUND
As one of the most common aesthetic surgical procedures carried out today, blepharoplasty should be in the repertoire of every plastic surgeon. The term blepharoplasty encompasses a wide range of techniques and options that must be tailored to the specific defect and patient one has to treat. A sound knowledge of the upper and lower eyelids’ anatomy is essential for proper surgical execution. Trends have shifted towards more conservative methods (especially of the fat compartment) and sometimes in combination with augmentation techniques, helping to reach a rejuvenated appearance.
AIM
To present an overview of the surgical techniques considered for upper lid blepharoplasty and fat pad management, in addition to information on how a surgeon may approach the best treatment for his patient based on current publications in literature.
METHODS
We searched the literature published between 2013, to 2023 using Medline and Reference Citation Analysis. The database was searched using the keywords “upper blepharoplasty” AND “fat”. Papers without full text/abstracts and reviews were excluded. The search strategy followed the PRISMA. The American Society of Plastic Surgeons guidelines for Therapeutic Studies checklist was used to assess all articles. Two authors individually reviewed each article and rated them for importance and relevance to the topic. A consensus was sought and the most relevant studies.
RESULTS
After the application of the selection criteria used in our review, 13 publications were found to address upper lid blepharoplasty specifically. Three of these studies were reviews and three were retrospective studies. Five publications were comparative studies and a further two were clinical trials.
CONCLUSION
The tendency of modern surgery is to be conservative, by removing adipose tissue only if strictly necessary and restoring the volume of the upper eyelid in a concept of beauty that espouses a "full" sight. There is no gold standard technique to achieve younger and enhanced eyelids. Long-term prospective comparative studies are fundamental in understanding which path is the best to follow.
Core Tip: Blepharoplasty is common cosmetic and aesthetic surgical procedure carried out by plastic surgeons. There are numerous option and techniques to address the individual needs of each patient. It is of clinical importance to diagnose underlying conditions, manage and treat individuals seeking this type of surgery. Patient outcomes, prevention of complications and success of therapy depend on selecting the most suitable option and applying the correct surgical technique to address the needs of each patient.
