Eyelid Surgery: Q&A
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Fat/tissue Sparing Blepharoplasty
Orbital hollowness is frequently a complication with traditional blepharoplasty. Fat sparing blepharoplasty addresses this issue by tightening the orbital septum and pushing orbital fat back into it's anatomical position. I would like to hear opinions on why fat sparing blepharoplasty is not more widely practiced. Would it be appropriate to use this procedure in cases with only mild orbital fat prolapse, and where the main issue is mid face descent? thank you for your answers
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9 Doctor Answers |
Asked by
nexus21
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Eyelid Surgery
The reason more fat sparing surgeries are not done is that most people we see need less, not more fat. We spare fat when necessary, avoid the hollow look, but most are visiting us to remove the fat, not to leave it in.
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Fat Sparing is Part of Properly Contouring
A thoughtful analysis is always a key element to a successful operative plan.
There are many approaches to adjust volume and contour around the eye and properly blend the lids with adjacent structures, especially the orbital rim and upper cheek.
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Fat Sparing Blepharoplasty
With each passing year I find myself performing less 'invasive' lower lid surgery (i.e a formal lower blepharoplasty) and more lower lid rejuvenation by means of structural fat grafting. The reality of aggressive lower lid surgery - which involves some combination of skin excision, fat pad reduction and/or fat pad transposition, orbicularis (muscle) redraping and excision, and canthal support (to hold up the lateral aspect of the lower lid while everything heals) - can easily...
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Respecting eyelid fat during blepharoplasty
Excellent question!! I have been preaching fat preservation during blepharoplasty surgery for years. I have quite a few patients that come to me to get that hollow eye look repaired after having a blepharoplasty elsewhere. Blepharoplasty surgery has made more advances over the last 2 decades then any other cosmetic surgery procedure. There are many options surgeons have to address patients with, it is no longer cookie cutter remove skin and fat. Now we can...
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Adding volume to lower eyelid grooves may look better than removing lower eyelid fat.
I read your comment, and agree that removal of lower eyelid fat may lead to an operated, hollow appearance. For this reason, I hardly ever remove lower eyelid fat. In my practice, Silikon-1000, an off-label filler for permanent results is preferred to fill lower eyelid grooves.
With upper blepharoplasty, I usually do not remove fat either. I will typically remove only a skin and muscle strip.
Regards from NJ.
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Fat Transfer and Grafting in Lower Blepharoplasty
Simply stated, we tend to lose facial fat and volume as we age. In my practice I save virtually all of the fat from the lower eyelid and in most cases transpose this into the hollow tear trough under the eye. I do leave this on the pedicle to preserve blood supply and insure a healthy graft that remains over time. Sometimes I will actually use facial fat transfers from abdominal fat liposuction to add additional volume to the lower eyelid. I personally believe that...
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Fat removal in lower eyelid surgery
Every patient is different. Some I remove some fat if it bulges, some I release the arcus marginalis to free the depressed line along the lower lid cheek junction. and some I remove some skin. It really depends upon the individual.
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Lower blepharoplasty options
The answer depends on the invdividual patient and his/her eyelid anatomy. The treatment needs to be invidualized. Some have significant buldgy lower eyelid fat pad, which requires removal. Some may benefit with fat transposition (moving the buldgy fat inferiorly to fill up the hollow area). Some benefit from fat or filler injection. Some may benefit from lower eyelid skin tightening. A combination of any of these options may be needed.
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The procedure you are referring to is called arcus marginalis release.
Traditional lower blepharoplasty or cosmetic lower eyelid surgery is performed through a skin incision below the lower eyelid lashes and may extend out into a lower crows feet line. The incision is typically deep enough to open the septum, a layer of connective tissue that separates the orbital contents from the more anterior eyelid. Just behind the septum is orbital fat which is the remove by the surgeon. Closure is the completed by excising "excess" lower eyelid skin. This type...
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