Fat management in upper blepharoplasty: Addition or subtraction blepharoplasties, how and when

Table 1 Research publications regarding upper blepharoplasty included in this study

Ref.	Year	Type of study	Race	Conclusions
Tonnard et al[8]	2013	Retrospective study with 500 patients	All	Fat grafting and careful trimming of unwanted skin tissue were generally used in these patients. The results were the preservation of eyelid volume and also the correction of sunken eyelids by fat grafting
Zoumalan and Roostaeian[10]	2016	Review	All	The authors concluded that the standard procedure for upper eyelid surgery is the excision of skin, muscle, and fat from the eyelids. They also recommended a browlift if needed
Zhou et al[11]	2014	Clinical trial	Asians	Authors observed that a stable supratarsal fold can be achieved by excising the pretarsal orbicularis oculi muscle. This procedure coupled with stripping of submuscular soft tissue and orbital fat resulted in a tough cicatricial connection from the levator aponeurosis to the skin
Alghoul et al[12]	2020	Comparative study	All	An opinion of upper eyelid appearance in the younger population was advanced. Characteristics suggested include smooth eyelid folds which are higher laterally with a symmetric pretarsal space. Eyelid volume should be subtle and flatter medially and fuller laterally
Figueiredo et al[13]	2017	Randomized controlled trial	All	Although not in a statistically significant way, the brassiere sutures introduced by Goldberg can help to obtain an upper eyelid with harmonious proportions and a fullness of the eyebrow-eyelid transition
Pacella et al[14]	2010	Review	All	A review of the transconjunctival technique for upper eyelid blepharoplasty is primarily effective in patients with minimal skin excess. Also, they advised that this procedure only gives access to nasal fat pad
Massry[15]	2011	Retrospective study with 76 patients	All	Surgery times can be prolonged by adjusting the position of the nasal fat pads. This critical step preserves upper lid fat, supplementing appearance after surgery
Lee et al[16]	2015	Comparative study	Asians	The authors posited that advancing the upper lid pre-aponeurotic fat can mitigate unwanted lid folds, thus resulting in better cosmesis
Collar et al[17]	2013	Review	All	When there is significant hollowing and no excess skin, the patient should undergo only augmentation procedures. One of such procedure for volume restoration of the upper eyelid is fat grafting
Park et al[18]	2011	Retrospective study with 50 patients	Asians	Authors suggested that the roof fat graft can be manipulated during blepharoplasty to produce better results