Abstract

Objectives: To introduce and evaluate a novel "hybrid" approach combining conventional lower blepharoplasty with micronized acellular dermal matrix (ADM) injection. This study aims to demonstrate how this technique overcomes the limitations of traditional methods by simultaneously correcting fat bulging, reinforcing the tear trough, augmenting the pretarsal roll, and improving dark circles without optical complications. Introduction: The aesthetic ideal of the lower eyelid is characterized by a smooth contour without septal fat bulging, a well-supported tear trough, and adequate volume of the pretarsal roll. Conventional surgical techniques, such as transconjunctival fat removal, transconjunctival fat repositioning, and lower blepharoplasty with skin excision are widely utilized. However, these methods have inherent limitations. Fat removal alone is insufficient for addressing tear trough hollowing. Conversely, fat repositioning often fails to completely resolve fat bulging and can relatively diminish the prominence of the Materials / method: A retrospective review was conducted on patients who underwent the hybrid lower blepharoplasty technique. Septal fat bulging was structurally addressed via standard lower blepharoplasty. Concurrently, micronized ADM was injected to restore volume in the sunken tear trough deformity. When necessary, targeted ADM injection was additionally performed to augment and define the pretarsal roll. Postoperative outcomes, including contour regularity, volume retention, and changes in skin tone, were clinically evaluated. Results: The hybrid approach yielded excellent aesthetic outcomes, achieving a smooth lower eyelid contour. Fat bulging was completely resolved, while the tear trough and pretarsal roll received sufficient, natural-looking volume reinforcement. Notably, unlike conventional HA fillers, the injected micronized ADM exhibited no Tyndall effect. Moreover, the intrinsic white color of the ADM provided a masking effect under the thin eyelid skin, brightening the overall skin tone and leading to a significant clinical improvement in infraorbital dark circles. Conclusion: Hybrid lower blepharoplasty combined with micronized ADM injection is a highly effective, complementary modality for lower eyelid rejuvenation. By structurally compensating for the volumetric deficits of conventional surgery and avoiding the Tyndall effect associated with traditional fillers, this novel approach provides comprehensive periorbital enhancement—simultaneously addressing fat bulging, tear trough hollowing, pretarsal roll flattening, and dark circles.