Abstract

Objectives: The objective of this study is to introduce a surgical method for repositioning and redistributing the medial fat pad to the central upper eyelid area during a subbrow lift. The goal is to restore fullness to sunken central regions while simultaneously improving medial upper eyelid bulging. Introduction: Aging begins early in the periorbital region due to skin loosening and bone resorption. Specifically, the central fat pad deflates more than the medial pad, causing medial bulging and central hollowing. While traditional blepharoplasty often removes fat, potentially causing a "skeletonized" appearance, the subbrow approach effectively improves lateral hooding. This method allows for orbicularis oculi muscle (OOM) tightening and fat redistribution to restore a youthful, natural contour. It is highly effective because results are distinctly noticeable to patients. Materials / method: From January 2023 to June 2024, 74 patients with excessive preorbital skin and no desire for double-fold changes underwent subbrow lift with OOM manipulation and medial fat repositioning. Follow-ups occurred at 1 week and 6 months post-surgery. Three blinded physicians used standardized photography to grade fat pad bulging on a 0–3 scale. Patient satisfaction was evaluated at 6 months via a 5-point Likert scale. Results: Fat Grade Changes: The medial fat pad grade decreased by an average of 0.8, indicating a reduction in nasal bulging. Conversely, the central fat pad grade increased by 1.3, indicating restored fullness in previously sunken areas.Patient Satisfaction: The procedure achieved a 78% satisfaction rate, with 25 patients reporting they were "much improved" and 33 reporting they were "markedly improved".Complications: Moderate to severe bruising and swelling occurred in six patients but resolved naturally within 6 weeks; no issues with scarring were reported. Conclusion: Subbrow blepharoplasty with orbital fat repositioning is a highly effective technique for addressing both the excess and deficiency of periorbital fat caused by aging. By leveraging the biological differences between fat pads, this method restores a youthful, harmonious contour with results that are distinctly noticeable and satisfying to the patients themselves.