Retrospective Follow-up Study on Lower Eyelid Melanin and Wrinkles After Blepharoplasty for Lower Eyelid Bags

This observational study aims to investigate the long-term outcomes of transconjunctival lower eyelid blepharoplasty, with a specific focus on changes in lower eyelid hyperpigmentation or hypopigmentation and morphological alterations of wrinkles at short-term and long-term postoperative time points. It further seeks to clarify the overall impact of this surgical approach on lower eyelid skin appearance.

The study addresses the following research questions:

Does transconjunctival lower eyelid blepharoplasty improve lower eyelid pigmentation? If so, to what extent is the improvement achieved? Does transconjunctival lower eyelid blepharoplasty exacerbate lower eyelid wrinkles? What adjunctive or combined surgical techniques may mitigate this effect? All study participants had previously undergone transconjunctival lower eyelid blepharoplasty for the purpose of periorbital rejuvenation.

Study Overview

• Status: Completed
• Conditions: Wrinkle Appearance; Melanin Hyperpigmentation
• Intervention / Treatment: Procedure: transconjunctival lower blepharoplasty; Procedure: POD lifting

• Study Type: Observational
• Enrollment (Actual): 120

Contacts and Locations

Study Locations

• China
  • Tianjin, China
    • Tianjin Eye Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of patients aged over 35 years, with prominent lower eyelid bags and accompanying tear trough deformities. Due to concerns regarding surgical scarring, all patients underwent transconjunctival lower blepharoplasty rather than a transcutaneous approach.

Description

Inclusion Criteria Lower eyelid bags Tear trough deformity Fear of surgical scars, refusal of transcutaneous lower blepharoplasty, and strong preference for transconjunctival approach Age older than 35 years Exclusion Criteria Previous lower eyelid surgery History of periorbital injections including hyaluronic acid, botulinum toxin, or other regenerative fillers Orbital or eyelid tumors Local infection Psychiatric disorders Lack of follow-up photographs

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Transconjunctival lower blepharoplasty; conventional transconjunctival lower blepharoplasty, this conventional approach combined of transconjunctival intraorbital fat excision and fat transplantation.	Procedure: transconjunctival lower blepharoplasty; Transconjunctival lower blepharoplasty is a minimally invasive surgical technique for lower eyelid rejuvenation. It accesses orbital fat through an internal conjunctival incision, avoiding external skin scars. It reduces fat prolapse, improves tear trough deformity, and preserves lower eyelid support, ideal for patients with prominent fat bags and minimal skin laxity.
Transconjunctival lower blepharoplasty combined with POD lifting; conventional transconjunctival lower blepharoplasty combined POD lifting in order to alleviate postoperative skin laxity.	Procedure: transconjunctival lower blepharoplasty; Transconjunctival lower blepharoplasty is a minimally invasive surgical technique for lower eyelid rejuvenation. It accesses orbital fat through an internal conjunctival incision, avoiding external skin scars. It reduces fat prolapse, improves tear trough deformity, and preserves lower eyelid support, ideal for patients with prominent fat bags and minimal skin laxity.; Procedure: POD lifting; POD lifting is a minimally invasive facial lifting procedure using absorbable polydioxanone sutures. It elevates sagging soft tissues by creating mechanical support and stimulating collagen production.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Barton's grading scale	The Barton Grading Scale is a validated clinical tool standardized for assessing the severity of lower eyelid contour deformities, particularly tear troughs and lower eyelid bags. It operates on a numeric or alphanumeric scale, typically ranging from 0 to 4 or Grade I to III, to quantify the depth of the tear trough and the degree of orbital fat prolapse.	Before the operation, and six months after the operation
Global Aesthetic Improvement Scale	Global Aesthetic Improvement Scale (GAIS) is a validated 5-point subjective scale used to evaluate overall facial aesthetic improvement from baseline, widely applied in clinical trials and skincare research. Raters (clinicians or participants) score from 1 (markedly improved) to 5 (much worse), often with a neutral midpoint. It complements objective measures by assessing holistic changes in wrinkles, skin laxity, tone, and texture. Standardized training ensures inter-rater reliability. GAIS is integral to quantifying treatment effects in periorbital rejuvenation and anti-aging studies, providing actionable global outcomes.	Before the operation, and six months after the operation
Periorbital hyperpigmentation assessment	Periorbital hyperpigmentation assessment includes both qualitative and quantitative evaluation. Qualitative assessment uses a 5-point scale: 0 = matched facial skin color; 1 = mild periorbital pigmentation; 2 = obvious pigmentation; 3 = severe dark color involving upper and lower eyelids; 4 = severe pigmentation extending beyond the infraorbital fold. Quantitative assessment compares pre- and postoperative grayscale values derived from standardized clinical photographs.	Before the operation and six months after the operation
Wrinkles in the lower eyelid	Wrinkles in the lower eyelid are evaluated using a quantitative method. The number and length of lower eyelid wrinkles are measured and calculated. Preoperative and postoperative changes are objectively compared to assess the surgical effect on wrinkle improvement.	Before the operation and six months after the operation.

Collaborators and Investigators

• Sponsor: Peking Union Medical College

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2021
• Primary Completion (Actual): September 1, 2025
• Study Completion (Actual): February 1, 2026

Study Registration Dates

• First Submitted: March 15, 2026
• First Submitted That Met QC Criteria: March 15, 2026
• First Posted (Actual): March 19, 2026

Study Record Updates

• Last Update Posted (Actual): March 19, 2026
• Last Update Submitted That Met QC Criteria: March 15, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: 2026（084）

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No