Bulging lower lids are not very attractive, but then hollowed eyelids can look even worse. One way to avoid the risk of trading one deformity for another is to go easy on removal of orbital fat during eyelid surgery. Here's why:
• Orbital Fat Does Not Increase With Advancing Age
Standard blepharoplasty is an operation based around the subtraction of bulging orbital fat and sagging eyelid skin. However, orbital fat does not increase with advancing age. By definition, then, any fat removed during blepharoplasty creates a shortage compared to a more youthful state.
• Something Bulging? It's Not That Easy to Correct
Both transconjunctival and transcutaneous lower blepharoplasty entail removal of orbital fat that is bulging against the lower eyelid and making it appear to be too full.
Determining the exact amount of fat that can be removed without causing hollowness is difficult. If removal is too vigorous, eyelid hollowness may appear just as soon as major swelling from the operation subsides. If removal is only a little bit too aggressive, hollowness may take a year or more to become noticeable.
• Removing Orbital Fat May Have Secondary Consequences
Excessively excising fat during lower blepharoplasty can set off a cascade of unintended regional anatomic changes . . .