Fat repositioning in lower eyelid blepharoplasty.

Abstract

Fat preservation and grafting techniques have gained popularity in lower eyelid blepharoplasty because surgeons recognize the failure of fat removal to address the tear trough deformity.1-4 Analogous to addressing brow ptosis when considering upper eyelid blepharoplasty, patients who present with requests for lower eyelid rejuvenation most often have accompanying midface descent. A tear trough deformity usually results from the descent of the suborbicularis oculi fat (SOOF) and malar fat pad, which produces skeletonization of the inferior orbital rim. An additional irregularity, the double convexity deformity, may occur as a result of lower eyelid pseudoherniated orbital-fat convexity above the inferior orbital rim and tear trough followed by the descended SOOF and malar mound convexity.5 We define fat repositioning as the repositioning of the lower eyelid pseudoherniated orbital fat inferiorly over the orbital rim, repositioning the SOOF superiorly over the orbital rim, or a combination of both techniques. We believe that this repositioning is a more physiologic approach to the sequela of the aging lower eyelid–cheek complex.