The lumbrical fat graft: a replacement for lost upper eyelid fat

Human eyelids seem to age earlier and more rapidly than do other regions of the face, making blepharoplasty (either age or familially indicated) an operation often performed earlier than other remedial procedures for facial aging. The traditional and more doctrinaire approach to upper blepharoplasty in which fat and orbicularis muscle are excised has led to a type of iatrogenia that often leaves the upper (and lower) eyelids hollowed and vacant, before their time. The notion of upper blepharoplasty as a simple operation is, therefore, to be questioned. The idea of normal and obligatory asymmetry as a key to recognizability is brought into relief when contemplating blepharoplasty. In questioning the judgments by which upper palpebral fat (and orbicularis muscle) is excised, the author suggests both a remedy-the lumbrical fat graft-and the need for a heightened awareness of the synergy such excisions make with the age-related palpebral fat atrophies. This is a report of 35 cases (70 eyelids), over a 24-month period, during which the current technique was used. The technique is relatively simple, the anatomy well known, the learning slope shallow, the results gratifying, and the complications and problems few and benign.