Tear Trough Deformity Correction With Autologous Fat Grafting Evidenced by Linear Gray Scale Analysis

BACKGROUND: Linear gray scale (LGS) analysis was an objective and reproducible approach for evaluating nasolabial folds and baggy lower eyelids. This study aimed to assess the aesthetic outcome of tear trough rejuvenation with fat grafting with patient satisfaction, Barton grading system and LGS analysis. METHODS: Patients who underwent fat grafting for tear trough correction at the authors' department from January 1, 2020 to December 31, 2024 were included in this study. The purified adipose tissue was injected supraperiosteally into the lower eyelid region using a retrograde linear threading method. The aesthetic results were analyzed by patient satisfaction and Barton grading system. LGS analysis was conducted as an objective assessment based on preoperative and postoperative photographs. The postoperative complications of tear trough correction were also recorded. RESULTS: Seventy-nine patients underwent autologous fat grafting for tear trough correction. The follow-up period varied from 3 to 9 months, with a median time of 3 months. No major complications occurred. 51.5% of patients rated themselves as very satisfied, whereas 22.2% expressed satisfaction. The tear trough deformity was rejuvenated after autologous fat grafting. Barton grades improved from 1.67±0.79 to 0.51±0.48 postoperatively ( t =5.932, P <0.001). The medial orbital gray scale (OGS) score decreased from 47.23±26.63 to 27.77±18.56 postoperatively ( t =3.90, P =0.002). The central OGS score decreased from 40.23±16.67 to 24.77±13.61 postoperatively ( t =4.66, P =0.001). The medial and central OGS scores were positively correlated with Barton grades (medial: r =0.817, P <0.001; central: r =0.813, P <0.001). CONCLUSIONS: Autologous fat grafting was effective in tear trough rejuvenation without major complications. A strong correlation was observed between the results of LGS analysis and Barton grading system. The LGS analysis was a standardized, objective, and quantitative method to evaluate the aesthetic results of tear trough correction.