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What is the Best Way to Treat Lower Eyelid Bags?

Lower eyelid surgery (blepharoplasty) that preserves fat is superior to procedures that strictly remove and sometimes move fat from other areas of the body.

Eyelid Aging is Complex

Multiple changes occur as the lower eyelids age, each aspect of which requires careful analysis and tailored treatment. Fat present in the lower eyelids pushes against the septum, or “wall” holding that fat back, resulting in eyelid bags. This is called fat pseudoherniation. There are two ways to address eyelid bags.

Fat Removal Only is Insufficient and Counterproductive

One, older, approach is reductive. This approach removes a portion of the fat in all three (3) fat compartments of the lower eyelid. The problem with removing fat from all three compartments is that this can leave an individual with a hollowed appearance which can accelerate the aging process.

Fat Grafting Can be Good in Specific Cases

The tear trough is a crease at the interface between the lower eyelid and cheek. The tear trough deepens as lower eyelid bags worsen and the cheeks droop. Known as fat grafting, fat from other areas of the body is often placed in the tear trough after fat from the lower eyelid is removed in overly reductive lower eyelid surgery. Fat grafting can work well for individuals who have previously undergone a reductive lower eyelid surgery (blepharoplasty) elsewhere. However, it is generally not the best approach to smooth out the bags and tear troughs in the lower eyelids if no surgery has previously been performed.

Fat Preservation and Transposition is a Superior Approach

Instead, the approach at Harmon Facial Plastic Surgery is to perform a fat transposition. This approach utilizes a significant portion of the fat present in the lower eyelids and repositions it into the tear trough rather than removing it entirely. The benefits of this approach are multiple. First, this fat more predictably keeps its volume because it still has its own blood supply, unlike fat transferred from other parts of the body. Second, it better smooths out the transition from the lower eyelid to the tear troughs and cheek, restoring youthful contours and significantly reducing the risk of appearing hollowed and aged. A more technically difficult approach, fat transposition can provide a more natural result than fat removal and grafting for those individuals who are undergoing lower eyelid surgery (blepharoplasty) for the first time.

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