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Three Steps Blepharoplasty to Correct Four Types of Lower Eyelid Deformities

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Hung-Chang Chen
Educational Background
• Education: 1997-2004 China medical university, Taichung, Taiwan
• Postgraduate Education:
June 2003 - May 2004 Internship, National Taiwan University Hospital
July 2004 - Dec 2005 Military service
Aug 2006 - Aug 2008 Residency in General Surgery, Chang Gung
Memorial Hospital, Linkou
Sep 2008 - Aug 2011 Residency in Plastic Surgery, Chang Gung
Memorial Hospital, Linkou
Sep 2011 - Aug 2012 Chief Resident in Plastic Surgery, Chang Gung
Memorial Hospital, Linkou
Sep 2016 - Jan 2018 Oculoplastic fellowship, Wilmer Eye Institute, Johns
Hopkins Hospital, Baltimore
Work Experience
• Attending doctor, Department of Plastic and Reconstructive Surgery, Chang Gung
Memorial Hospital, Linkou, Taiwan
• Clinical observer, Aesthetic & Plastic Surgery Institute, Irvine Medical Center Orange
County, California, USA
• Clinical observer, Division of Plastic Surgery, Brigham and Women's Hospital,
Harvard Medical System, Boston, Massachusetts, USA
• Oculoplastic fellowship, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore

Topic: Three Steps Blepharoplasty to Correct Four Types of Lower Eyelid Deformities
Abstract:
Background This study aimed to propose a novel four-type deformity and treatment-oriented
classification of the lower eyelids that directs the therapeutic combination of three-step
lower blepharoplasty for Asian populations.
Methods We reviewed 183 patients who underwent a therapeutic combination of three steps of lower
blepharoplasty after being diagnosed with four types of lower eyelid deformities between July 2018 and
April 2021. The three step lower blepharoplasty includes: (1) mid-face and lower
eyelid augmentation, (2) transconjunctival eye bag removal, and (3) skin pinch removal. Consecutive
digital images, detailed fat graft volume, fat removal amount, skin pinch removal amount, complications,
and patient's satisfaction and aesthetic improvement score were recorded.
Results The overall patient's satisfy score is 91. Aesthetic improvement score is 80.2 and 83.3 among lay
persons and experts, respectively. The volume of the fat graft ranges from 2 to 3 mL per orbit according
to the severity of the deformity. The amount of fat removed was 0.53 ± 0.36 and
0.61 ± 0.40 mL per orbit in types II and III patients, respectively. There is no lower lid malposition. Eleven
patients had over-correction of fat grafting, and they need steroid injection; 20 patients had
under-correction of fat grafting, and they need secondary fat grafting. Ten patients
need secondary skin pinch excision due to post-op skin redundancy. Two patients had conjunctiva wound
granuloma. Conclusions The combination of three-step lower blepharoplasty
according to the novel classification is a straightforward and effective method to correct lower
eyelid deformities. The complication rate was low with high patient satisfaction

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