Blepharoplasty. Removing fat versus tightening the membrane to hold it in.

I am nervous about fat removal during blepharoplasty creating a hollow look later on. is the new procedure to tighten the membrane instead of fat removal just a gimmick? If it creates better results why aren't all occuplasticplastic surgeons using it?

Doctor Answers 4

Blepharoplasty, hollow eyes

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Thank you for your question. A hollow eye is not a complication of carefully removed orbital fat. The new technology your referred to is a septal reset, which repairs the orbital septum. This is the lining that covers your fat gives you a more natural result. All the best..Dr T Narsete Denver Plastic Surgeon

Blepharoplasty techniques

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Removal of fat excess is performed very frequently during blepharoplasty surgery. When done correctly and concervatively, it should not lead to hollowing of the eye socket. Tightening of the orbital septum is one of the key steps in achieving a natural long lasting result and preventing potential complications of eyelid surgery. However, one cannot compensate for no the removing fat excess by overtightening the septum- most frequently these two steps need to be done concomitantly to achieve nice result. 

Tightening the skin in the preseptal location instead of fat removal for lower lid blepharoplasty

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Many individuals are inclined to have less invasive techniques to avoid an "over-done" appearance - particularly when it comes to lower lid blepharoplasty. A very judicious amount of fat removal or repositioning is unlikely to cause a hollow appearance later, however, in my experience, many patients are pleased with gentle laser resurfacing to tighten the skin over the preseptal area. This may be done in an office setting, with or without filler injection over the zygoma to reduce the tear trough depression. See an oculoplastic surgeon who is experienced with lasers and fillers to inform you of these less invasive options. Best wishes.

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Removing fat vs tightening "membrane"

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The membrane you are referring to is called the septum, a fibrous structure, which forms a sort of wall to keep the fat back.  In some cases, tightening the septum may be done, but almost always with some fat removal.  The reason for this is due to the need to shorten the length of the septum during reinforcement. This can lead to a downward pulling of the eyelid from above, resulting in ectropion.  There may not be enough support to keep the fat from bulging with an unacceptable result.  Your surgeon should be aware of how much fat to remove during surgery.  The key is to remove just enough or less than that so that if you need a revision more fat can be removed, as opposed to having to put fat back in.  Cheers and good luck

Hugo Higa, MD
Honolulu Oculoplastic Surgeon
5.0 out of 5 stars 1 review

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