An Integrated Surgical Strategy to Lower Blepharoplasty With Quantitative Classification and Assessment in Asian People.

BACKGROUNDS: Lower eyelid bag deformities exhibit considerable variation among patients, necessitating tailored approaches rather than a standardized procedure. This study aimed to establish a clinical grading system and develop an integrated surgical strategy for Asian patients to achieve personalized and satisfactory outcomes in lower blepharoplasty.

METHODS

Between January 2021 and June 2024, a total of 504 patients with grade I-III lower eyelid deformities underwent a combined procedure involving transconjunctival orbital fat removal, minced orbital fat grafting, and skin excision. Preoperative and postoperative photographs, patient satisfaction, aesthetic improvement, complications, and statistical evaluations were analyzed.

RESULTS

The cohort included 90 patients with grade I, 301 with grade II, and 113 with grade III deformities. Overall patient satisfaction was high (4.456 ± 0.22), with the highest scores observed in grade III patients. The total aesthetic improvement score was 90.98 ± 2.23, with grade II patients demonstrating the most significant enhancement. More severe deformities were associated with lower AC/AB ratios, higher AG/AB ratios, and greater ∠GOH. Preoperative values of AC/AB (>0.82), ∠EDO (>7.79), AF/AB (>2.53), and ∠GOH (>18.65) were predictive of marked aesthetic improvement following surgery.

CONCLUSIONS

Successful lower blepharoplasty relies on precise preoperative assessment and individualized planning. Through a quantitative clinical grading system (grades I-III based on our FTS staging framework) and a personalized integrated surgical strategy, we observed generally satisfactory outcomes in Asian patients with varying presentations of lower eyelid bag deformities. Preoperative quantitative assessment may help standardize clinical description and guide surgical planning, thereby facilitating expectation management regarding potential aesthetic improvement.