Fat Grafting via the Supraorbital Approach for Upper-Eyelid Depression Correction: A Retrospective Study

To evaluate the efficacy and safety of combined double-eyelid revision and autologous fat grafting via the supraorbital approach for correcting post-blepharoplasty upper-eyelid depression.

A consecutive retrospective cohort of 32 patients (30 females; mean age 43 years) with post-blepharoplasty upper-eyelid depression underwent combined double-eyelid revision and autologous fat grafting via the supraorbital approach between January 2020 and January 2025. Lipoaspirate obtained from the thigh or abdomen was refined by centrifugation and injected into the retro-orbicularis oculi fat (ROOF) layer through the same supraorbital incision. Efficacy was assessed six months postoperatively using the Global Aesthetic Improvement Scale (GAIS) and a 5-point patient-rated Likert scale.

All 64 eyelids achieved immediate volume restoration and a natural supratarsal fold, no palpable nodules or eyelid dysfunction occurred. At 6 months, 81.3% (26/32) were judged "very much improved" and 12.5% (4/32) "much improved" on GAIS; 87.5% (28/32) self-rated the outcome as "excellent." Mild recurrent hollowing occurred in 4 patients (12.5%), of whom 3 underwent secondary grafting.

The supraorbital route enables accurate placement and even distribution of fat with minimal trauma during revision double-eyelid surgery. Upper-eyelid depression was effectively corrected and aesthetic outcomes significantly improved, confirming the feasibility and safety of this technique in a single-center retrospective cohort.

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