Lower eyelid fat bulging in a middle-aged man
(Surgical series shows patient's right eye)
A skin incision is made below the lashes across the length of the lower lid. The orbicularis muscle is left intact.
Dissection exposes the weakened orbital septum and fat hernia.
The orbital septum is opened. The capsulopalpebral fascia is identified above and the rim of orbital bone below.
The first suture is placed into these two structures and over the fat. As the suture is tightened and tied, the fat is pushed back into the orbit.
As suturing progresses (black arrows), the fat hernia is gradually reduced.
After the final suture is tightened, the bulging fat is fully returned into its natural orbital compartment. No fat or muscle are removed.
Excess skin, if any, to be removed is marked. In cases of poor eyelid support, canthopexy may be performed through this same incision.
Next: Conjunctival Approach Tissue-Sparing
Lower Blepharoplasty Photos