Subcutaneous Fat in the Upper Eyelids of Asians: Application to Blepharoplasty

The Asian eyelid has distinctive anatomical properties. Although the upper eyelid is reported in the literature to have no subcutaneous fat layer, we have often noticed adipose tissue below the upper eyelid skin during ophthalmic plastic surgeries. The aim of the present study was to examine the anatomical and histological features of subcutaneous adipose tissue in Asian upper eyelids using biopsies and microscopic morphological analysis. A total of 30 Chinese patients (60 upper eyelids) undergoing upper blepharoplasty were evaluated. The subcutaneous fat in the upper eyelids was surgically harvested and examined histologically. This study yielded two main findings. First, upper eyelid subcutaneous fat was found in 28 of the 30 patients. This fat layer was the inferior extension of the eyebrow subcutaneous fat layer, which descended and covered the superior half of the upper eyelid. Second, the lobules of subcutaneous fat in the upper eyelid were surrounded by dense fibrous tissues, and the fat cells were smaller than abdominal adipocytes but similar in size to orbital fat cells. Subcutaneous fat tissue is prominent in the upper eyelids of most Asians and is one important contributor to the bulky appearance of those eyelids. Clin. Anat. 33:338-342, 2020. © 2019 Wiley Periodicals, Inc.