Lower Blepharoplasty: Removing Fat or Repositioning It

It Is Not a Surgery That Only Cuts Away Skin

Lower blepharoplasty is not simply a surgery that cuts away the sagging skin under the eye.

With age, sagging under-eye skin, protruding fat, and a groove under the eye appear together. For this reason, a process that corrects the whole under-eye structure in a balanced way is needed.

In lower blepharoplasty especially, how the under-eye fat is handled is important. Fat repositioning, fat removal, and orbital septum reinforcement (septal reinforcement) are the three key approaches.

What Changes Occur Under the Eyes?

With age, several changes appear under the eyes at once.

• The skin under the eyes becomes thin and sags.
• The under-eye fat is pushed forward and bulges out.
• The tear trough (a long groove that forms under the eye) deepens, and dark circles become darker.
• The midface (front cheekbone) sags, and wrinkles form.

When these changes combine, the impression becomes one of looking tired and older.

The Standard These Days Is “Preservation”

Lower blepharoplasty may look similar from case to case, but there are surprisingly many different methods. The direction these days is a conservative approach.

• Skin removal is kept to a minimum.
• Fat removal is kept to a minimum.
• Dissection (the extent to which tissue is separated and entered) is kept to a minimum.
• Tissue is preserved as much as possible.

What It Means to Tighten the Membrane That Holds Fat Back

Because fat repositioning does not remove the fat, it can also help fill out a hollow front cheekbone. Conversely, if there is too much fat, removing some is needed.

However, if too much fat is removed, the area under the eyes can become hollow and look even more tired. That is why “minimal removal” is the principle.

We Look Beyond the Under-Eye Area to the Front Cheekbone

The lower eyelid and the midface (front cheekbone) should always be looked at together.

When the front cheekbone becomes hollow, the shadow under the eye gets darker, and the wrinkle that runs down from the front cheekbone becomes more prominent. This is why correcting only the under-eye area can make the under-eye area look less changed.

So depending on need, midface lifting, front cheekbone fat grafting, and restoring volume around the nasolabial folds may also be considered together. What to do together is decided during the examination.

The Most Important Principle Is “Not Excessive”

The difficulty of lower blepharoplasty lies in how appropriately to remove and how much to preserve.

• Skin removal should be kept to a minimum. If it is excessive, there is a risk of ectropion (a condition in which the edge of the lower eyelid turns outward).
• Fat is removed only to the minimum.
• Dissection is done only to the extent needed.

Preservation, naturalness, and safety. We look at these three together.

Summary

Planning in the direction of preserving tissue is the standard we hold.

Surgery time, anesthesia, the suture removal schedule, and side effects are summarized in [Lower blepharoplasty surgery information](/eyes/lower-blepharoplasty).