With my experience of more than 700 cases for lower eyelids rejuvenation in the past decade, I would like to share my current treatment options for deformities of the nasojugal groove (tear trough)/the lid-cheek junction (malar palpebral junction) and baggy eyelids.
First, for minimal to moderate baggy eyelids with deformity of the tear trough/lid-cheek junction, I simply applied the MAFT (micro-autologous fat transplantation) technique by delivering tiny fat parcels at a volume of 1/240 mL, with the assistance of a patent instrument, MAFT-GUN (Dermato Plastica Beauty Co., Ltd, Taiwan). The long-term follow-up demonstrated the promising effects of correcting the baggy appearance, improving the infra-orbital dark circle, and recontouring the deformity of the trough/lid-cheek junction (Figures to be presented).
Second, for moderate to severe baggy eyelids with deformity of the tear trough/lid-cheek junction but without skin redundancy, I adopted transconjunctival lower blepharoplasty with orbital fat removal, and MAFT for recontouring the deformity on the tear trough/lid-cheek junction and mid-face soft tissue deficiency. In my series, most candidates for this strategy were under 40 years of age.
Third, for moderate to severe baggy eyelids with skin redundancy and deformity of the tear trough/lid-cheek junction, I performed transcutaneous (subciliary approach) lower blepharoplasty by minimal skin excision and conservative orbital fat removal and MAFT for recontouring the deformity on the tear trough/lid-cheek junction and mid-face soft tissue deficiency [1]. This strategy might be indicated for any patient aged >50 years because of skin redundancy. However, for any patient in their 40s, skin redundancy might be an indicator of the third strategy instead of the second strategy.
Recontouring of the associated problems in lower eyelid deformities relies on good revolumization over the tear trough/lid-cheek junction and in the mid-cheek in some cases. Autologous fat transplantation is the best treatment option for this issue. The errors we made, concepts we have learned, techniques we are pursuing, and, of course, more innovative instruments such as MAFT-GUN [2] to be developed2 together will bring a better stage for our field.

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