Comparative Evaluation of Medial Septal Fat Excision During Infrabrow Blepharoplasty for Medial Upper Eyelid Fullness: A Retrospective Study

Background/Objectives: Medial upper eyelid fullness resulting from septal fat prolapse during infrabrow blepharoplasty has not been consistently addressed. However, the potential benefit of medial septal fat excision in enhancing the medial contour remains unclear. This study aimed to evaluate the efficacy and safety of medial septal fat excision during infrabrow blepharoplasty. Methods: This retrospective comparative cohort study included 488 patients who underwent infrabrow blepharoplasty with at least 6 months of follow-up. The patients were divided into the excision (n = 358) and non-excision (n = 130) groups based on the medial septal fat excision status. Medial fullness was graded using a standardized 4-point photographic scale. The primary outcome was the change in medial fullness grade (Δ). Analyses were performed at the patient level, selecting the eye with higher preoperative grade. Analysis of covariance was used to adjust for baseline differences. A subgroup analysis was performed for patients with mild baseline fullness (grades 1–2). Results: The excision group demonstrated significantly greater improvement in medial fullness. After adjustment for baseline differences, postoperative scores were significantly lower in the excision group, with an adjusted mean difference of −0.395. Subgroup analysis confirmed superior improvement in the excision subgroup. The complication rates were low and comparable between the groups (15.4% vs. 10.0%), with no increase in major adverse events. Conclusions: Medial septal fat excision during infrabrow blepharoplasty significantly enhances medial upper eyelid contour without increasing complication rates. This approach is a safe and effective adjunct for addressing medial fat bulging.