Background:
Fat grafting is increasingly used as a kind of autologous filler in facial rejuvenation. As an adjuvant surgery to blepharoplasty, a fat graft can refill the volume loss of an aged face and, furthermore, promote cellular regeneration in a molecular aspect. However, complications such as hematoma, infection, seroma, and palpable mass can occur. We collected the patients who underwent lower blepharoplasty or total blepharoplasty combined with fat graft to evaluate the incidence of oil cyst formation in the lower eyelid, identify risk factors, and to refine the procedure to achieve better outcomes.
Material and Methods:
A retrospective review was performed of all patients who underwent lower or total blepharoplasty combined with fat graft at the authors’ institution between January 2018 and June 2020. Complication rates were observed, and associations between preoperative variables and outcomes were assessed to evaluate the complication rate of oil cyst formation.
Results:
A total of 119 patients were included in the series (all bilateral, 238 eyelids). The average patient age was 54.88±11.94 years, and the average grafted fat was 1.88±1.0 ml. On a per-eyelid basis for all patients, the complication rate of oil cyst formation was 6.72 percent (16 of 238 eyelids). The average age of patients with oil cysts formation was 56.38±9.96 years. The occurrence of oil cyst formation was associated with hypertension (HTN, p-value = 0.012, adjusted odds ratio (Adj-OR) = 9.27, 95% confidence interval (CI) (1.62-52.99)) and diabetes mellitus (DM, p-value = 0.005, Adj-OR = 14.02, 95% CI (2.22-88.45)), but not associated with anticoagulants use (p-value = 0.931), age (p-value = 0.784), gender (p-value = 0.317), or fat volume (p-value = 0.215). The mean interval between the fat graft procedure and oil cyst noted was 236.5±118.9 days.
Conclusions:
Oil cyst in lower eyelid can be defined as a palpable, firm, and persistent subcutaneous cystic lesion found postoperatively in any size during physical examination. The complication rate of oil cyst formation occurring after lower blepharoplasty with autologous fat grafting is 6.72%. Hypertension and DM maybe are risk factors of oil cyst formation. Steroid injection, needle capsulotomy, liposuction, and excision are safe and effective treatments. Reduce surgical trauma by diminishing anterior lamina trauma and CPF repair might decrease the complication rate of oil cyst formation. TCLB with fat graft or two-stage surgery may be a choice to prevent oil cyst formation.

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