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J Cosmet Dermatol. 2019 Mar 20. doi: 10.1111/jocd.12922. [Epub ahead of print]

A quantitative, objective method for evaluating the surgical outcomes of baggy eyelid correction using orbital gray scale analysis.

Yang S1,2, Kim BR1,2, Kim HS3, Choi CW2, Jo SJ1,4, Youn SW1,2.

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Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
III's Dermatology Clinic, Seoul, Korea.
Department of Dermatology, Seoul National University Hospital, Seoul, Korea.



Baggy lower eyelids (BLEs) are a common cosmetic problem that is treated using various methods. However, validated objective methods for evaluating the treatment are limited.


A novel BLE correction procedure, transconjunctival fat resection, and subsequent fat grafting, was assessed using the orbital gray scale (OGS), a previously suggested objective measure for BLEs.


All patients were evaluated using both the tear trough rating scale (TTRS), a surgeon-derived evaluation method, and OGS, an objective computer-derived assessment. Changes throughout the surgery and their relationship to clinical characteristics, as well as the association between the two measurements, were statistically analyzed.


A total of 50 patients who underwent surgery were analyzed. No major complications other than wrinkles were observed. All patients showed improvement in both the TTRS scores and OGS values (P < 0.05). Lateral OGS was improved to a greater extent in older patients (P < 0.05). Medial OGS change was associated with improvement of tear trough depression (P < 0.05). Lateral OGS change was related to decreased infraorbital fat herniation (P < 0.05). Total OGS change was related to improvement of both tear trough depression and fat prolapse (P < 0.05).


The total OGS change was significantly associated with improvements in tear trough depression and fat bulging. Therefore, it could be a convenient objective evaluation measure for eyelid correction procedures.


Baggy lower eyelids; blepharoplasty; infraorbital fat herniation; orbital gray scale; tear trough


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