Electrosurgical blepharoplasty: a technique that questions conventional concepts of fat compartmentalization

Traditional teaching on blepharoplasty surgery emphasizes the existence of several discrete fat compartments in the upper and lower lids. Surgical techniques are based upon removal of fat from each of the two or three so-called compartments within the upper or lower lid. Anatomically, there is little basis for assuming the existence of such compartments. They usually represent areas of weakness or dehiscence within the overlying muscle or septum. A technique of blepharoplasty using electrosurgical dissection is described which emphasizes wide incision of the orbital septum with abundant presentation of the entire fat pad. Removal of fat is carried out without clamping and with great assurance that there will be no subsequent bleeding. Since it is not necessary to pull on the fat pads, retraction of open vessels is avoided.