Efficacy and safety of lower blepharoplasty with fat preservation: comprehensive systematic review of contemporary evidence

Introduction: Traditional lower blepharoplasty based on orbital fat excision has been associated with late deformities, such as orbital excavation, eyelid retraction, and unsatisfactory aesthetic results.Techniques involving fat preservation and repositioning have emerged as an alternative to restore eyelid contour and reduce complications.Objective: To comprehensively evaluate the efficacy and safety of lower blepharoplasty with fat preservation compared to techniques based on fat excision.Methods: Systematic review conducted according to PRISMA guidelines.The PubMed/MEDLINE, Scopus, and Web of Science databases were searched, including studies published between January 2000 and December 2025.Original clinical studies evaluating lower blepharoplasty with preservation or repositioning of orbital fat were included.The outcomes analyzed included aesthetic satisfaction, objective evaluation of eyelid contour, complication rates, eyelid malpositions, functional changes, and the need for reoperations.Results: Twenty-one studies were included, totaling 1,284 patients.Patient satisfaction ranged from 85% to 96%.Fat preservation techniques had lower rates of orbital excavation (2-6%), apparent sclera (1-4%), and ectropion (