Trimming the fat… or putting it to good use?

There is a particular look to an overdone eyelid surgery, where all the fat around the eye has been removed. It looks hollow – likes the eyes are set back too deep – and patients can look tired or even ill. Though each patient is unique and requires an individualized approach to eyelid rejuvenation, I have found that some basic rules of thumb apply. In general, rejuvenation of the upper eyelids is primarily a skin procedure. Almost no fat should be removed in the great majority of cases, and when fat is removed, it’s usually the fat closest to the nose.

This helps to avoid the “scooped out” appearance and an apparent over-elongation of the upper eyelid. The result is a much more natural contour – and greater ease applying makeup to highlight the eyelids and lashes!

The lower eyelids are less straightforward. Many patients have fullness or “bags” under the eyes, particularly right under the eye and laterally. In some patients, even if they have “bags,” a hollow area is seen toward the nose (sometimes called the “tear trough” region). Lastly, there may be extra skin or redundant lower eyelid muscle as well. In many cases, surgeons recommend removal of the fat from the lower eyelid region from inside the eyelid (transconjunctival approach). This is sometimes paired with a trim of a tiny amount of skin under the lashes, or, in some cases, addition of fat taken from elsewhere on the body. In the former case, removing the fat from the lower eyelid region can actually make the eyes look older and more hollow. In the latter case, addition of fat from other parts of the body is unpredictable – it can lead to undertreatment, overtreatment, unevenness between sides, or no results at all.

In my practice, I recommend a lower eyelid procedure that uses the fat pads already present under the eye to fill in the tear trough. This fat is guaranteed to survive, since it remains attached to its blood supply; plus, it’s almost always just the right amount. Next, I lift the skin of the lower eyelid and upper cheek region, removing the excess by the outer corner of the eye. This helps to improve the lower eyelid contour, gets rids of folds and wrinkles, and avoids the hollow look that can happen with other approaches. Most importantly, the results look natural.

For more information about surgical and non-surgical rejuvenation, please visit SanFranciscoFacialPlasticSurgery.com or call 415-550-1077 today for a comprehensive consultation!

Evan R. Ransom M.D.
Board Certified Facial Plastic & Reconstructive Surgeon