Before: Right lower eyelid fat bulging with mild tear trough depression.
A conjunctival incision is hidden on inside surface of lower eyelid and produces no external scar.
Dissection exposes the orbital septum. Arrow notes point of septal thinning that allows for forward herniation of orbital fat that accounts for external bulging.
Arrow shows the orbital rim of bone located below the eye. Its lining is thick and strong.
The first suture is placed through this lining on the side closest the nose.
The suture is advanced over the fat hernia and into the intact strong edge of orbital septum.
As the suture is tightened, the bulging fat is pushed back into its normal position inside of the orbit.
As suturing progresses, more fat is pushed back into its natural position.
Multiple sutures between the edge of the hernia sac and the lining of the bone provide a firm reduction of the orbital septal hernia.
The orbital fat hernia is now fully reduced. The septum is intact across the entire lid and pushing all bulging fat back into the orbit.
Immediate postoperative view
Note the absence of bulging and
a softening of the tear trough
depression. No fat was removed
* * *
Optional Temporal Fat Trimming
Left lower eyelid fat bulging with slight temporal fullness
Tissue-sparing blepharoplasty works best to reduce nasal and middle fat pocket herniation. When temporal fat pocket fullness is objectionable, this fat may either be ignored, trimmed slightly, or, less commonly, repositioned back into the orbit. Both tissue-sparing and temporal fat trimming procedures can be performed at the same time.
A transconjunctival incision is made for exposure of the temporal fat pocket.
Excess fat is trimmed conservatively.
Next: Canthopexy and Canthoplasty