Lower eyelid blepharoplasty with fat repositioning

Lower blepharoplasty surgery is the cornerstone of cosmetic rehabilitation of the lower eyelid and midface. A youthful appearance is defined by a harmonious continuum between the lower eyelid and cheek. A prominent nasojugal fold (tear trough), facial deflation, and pseudohernation of orbital fat into the lower eyelid characterize the aging face. The perceived eyelid-cheek junction in the young is defined by the lower eyelid crease and, with aging, it descends, changing from the smooth S-shaped contour with a crease defined close to the lid margin to a posteriorly directed V-shape below the orbital rim (Fig. 15.1). The tear trough, in our view, is an external manifestation of the orbicularis retaining ligament, and its prominence is enhanced by pseudoherniation of the orbital fat and descent of the deflated midface (Fig. 15.2). While the tear trough deformity may appear in youth, exacerbation is common with age and generates cosmetic complaints. Commonly, patients evaluated for lower eyelid blepharoplasty have complaints of lower eyelid bags, a tired appearance or dark circles around the eyes.