Fat management in lower lid blepharoplasty

Aging of the lower eyelid involves a complex series of anatomic and physiologic changes that occur over time. Rejuvenation of the lower eyelid complex must systemically address the various contributions of soft tissue laxity, pseudoherniation of orbital fat, and loss of periorbital volume. This article outlines the evolution of our approach to lower eyelid blepharoplasty with a specific focus on the importance of management of fat in the periocular region. A discussion of various surgical approaches with their advantages and disadvantages is presented, and the importance of maintaining a safe lower eyelid is emphasized. A comprehensive and systematic approach to restoration of the lower eyelid is highlighted with specific postoperative results.