Steps 6-9 (optional) are used only if the patient shows definite evidence of excess fat in the upper middle fat pocket. Otherwise, the orbicularis muscle and orbital septum are not opened, and the operation continues at step 10.
6. Muscle fibers separated
7. Opening orbital septum
8. Central fat exposed
9. Conservative trimming
Nasal fat is trimmed in the majority of cases
10. Trimming nasal fat
11. After fat trimming
Step 12 (optional) is now rarely used except in patients with clear evidence of muscle stretching.
12. Trimming muscle
Step 13 (optional) allows for the creation of a slightly higher and deeper crease in selected patients.
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