Correction of true periorbital fat herniation in cosmetic lower lid blepharoplasty

The presence of puffy, baggy lower eyelids is one of the first signs of the aging face. Baggy eyelids can result from excessive eyelid skin, hypertrophied orbicularis muscle, and/or periorbital fat herniation. An exact diagnosis of which components are contributing to the problem must be made in the preoperative period so that proper correction can be made during surgery. The concept of true periorbital fat herniation in the causation of baggy lower eyelids is presented. The surgical correction of this anatomic defect involves identification and approximation of the dehiscent orbital septum to the capsulopalpebral ligament. Thirty-five patients who presented with true lower eyelid fat herniation and who underwent direct suture repair are reviewed.