The Anatomy of Lower Eyelid Fat Pad Vasculature as Found in Lower Eyelid Blepharoplasties

The vasculature within the lower eyelid fat pads in bilateral lower eyelid blepharoplasty (BLLB) surgery is not well described. Characterization of vasculature may help prevent excessive bleeding by describing the locations where pre-emptive cautery may be indicated. We hypothesize that during BLLB, vasculature is most often encountered within the nasal fat pads compared with the central and lateral fat pads.

Retrospective chart review of patients who underwent BLLB by a single surgeon was performed. Patients were included if they underwent transconjunctival BLLB with documentation of the encountered intrafat vasculature (I-FV). I-FV was defined as the vessels coursing through the nasal, central, and lateral fat pads and excludes the fine vasculature in the surrounding fat pad sheath. If I-FV was present, it was recorded as "mild," "moderate," or "large." If no vasculature was observed, "minimal" vasculature was documented.

A total of 222 lower eyelids of 111 patients were included. About 78% (173/222) of lower nasal fat pads contained I-FV, which was statistically higher than the 15% (33/222) of lateral ( p < 0.001) and 5% (10/222) of central fat pads ( p < 0.001). Symmetry in the presence or absence of I-FV between the left and right sides was found in 65% (72/111) of patients.

During BLLB, I-FV is most prevalent in the nasal fat pads than in the central or lateral fat pads. We recommend extra caution and potential pre-emptive cautery when manipulating the nasal fat pad to prevent bleeding. The pattern of vasculature encountered on the first operative site may provide insight into the contralateral side.