Dr. John Martin: Hi, I'm Dr. John Martin, and in this segment, we're going to show you how I do a lower lid blepharoplasty with fat repositioning. Now, as we age, a lot of people start to notice that the fat bulges in their lower lid, and what they want to do is get rid of those so they look younger. In the past, we used to take out all the fat, but sometimes that would leave you with a hollowing which actually can make you look older. Now, what we try to do is take the fat and reposition it. So, what we do is from the inside, take the fat, and actually move it further down to fill in the hollowing that has developed. And then, we will usually tighten over in the corner here to help re-establish the normal anatomy of the eyelid by pulling it up, tightening it, and taking off a little bit of skin.

Female: [inaudible 00:00:48]

Dr. John Martin: Now we're going to do an incision in the conjunctiva in the inside of the lid. This will take us down into the fat pads. We can start to see the fat pads poking through here. We're going to put to a different setting on our laser. This will help us open up the fat pads a little bit more, free them up so they'll be ready to be put down into the tear trough, into the depression. So, we're going to preserve this fat. And he has a lot of fat, which is good for repositioning.

Female: Recording.

Dr. John Martin: Now we're going to cut the tendon here to give us more exposure, so we protect the eye with a metal shield. It will allow us better access. You can see with a laser you get very little bleeding. Down here. Move that a little bit. What we want to do is free up these fat pads so that they can easily be transposed down into our tear trough. Then what we're going to do is make a little incision. Here's our bone. You want to free up the periosteal bone. You can make a tunnel for our fat. Right on the bone there.

Female: Recording.

Dr. John Martin: We're going to take out a little bit of our lateral fat pad here. This one becomes a little bit large and creates a little bit of puffiness over on the side here, so this one we had to trim a little bit. Alright, okay.

Female: Recording.

Dr. John Martin: So, hold this fat back, and what we want to do now is create a little tunnel. This is what we call a subperiosteal tunnel underneath the lining of the bone. Some people go above this. Some people go below this. Do it either way. Get out a little further here, and you'll get to the nerve and some blood vessels, so try to stay away from those. And you can see our tear trough is right here, and we're definitely have dissected underneath it. And going back in. So that once we put this fat down in there, it should definitely help to fill this whole area in. Here we go. Can you see that [inaudible 00:05:03]?

Female: Yup.

Dr. John Martin: See the...? This is where our fat's going to go now down on top of the bone to fill that in.

Female: Okay.

Dr. John Martin: Now, we'll lift up the skin, hold the fat back, put in a suture from the skin side, which we'll push through. I'll grab this fat here. It's our medial fat pad. Stick a little bite through it. Back in here, [inaudible 00:05:42] this skin. Hold this up. You can see that the fat is now going to be pushed down. That fat goes right down into that little pocket there. And we'll put three of these sutures along here to fill in this trough.

Lower Eyelid Blepharoplasty: Minimal Bleeding With the Use of a Laser

LoDr. John Martin performs a lower eyelid bleph on a male patient, taking us into the operating room to show just how precise the surgery can be with the help of a laser.