Removal of Excessive Skin and Fat from the Lower Eyelids

Baggy lower eyelids are generally due to the protrusion of fat normally contained behind the eyelids, into the lower lid areas.  Removal of this fat empties the "bags" and removal of excess skin tightens the surface of the lower lids to achieve a smoother, more youthful appearance under the eyes.

Usually, this procedure is performed by an incision on the inner side of the eyelids to remove the fat and a small incision in the outer corner of the eyelid to tighten the skin.  Occasionally, an incision is needed under the lower lid lashes.

Before and After Photos

Before Photo		After Photo

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Fat Repositioning

At times protrusion of lower eyelid fat is associated with a depression or hollowing over the cheekbone, producing a circle effect.  In such cases, repositioning the fat into these areas reduces the bags and fills in the depressions.

Before and After Photos

Before Above :: After Below		Before Above :: After Below

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Details of Surgical Technique for Excision of Lower Eyelid Fat (Internal Approach) And Plication To Tighten Skin

A. An incision is made on the inside of the lower eyelid.
B. Excessive fat is removed from the inside eyelid approach.
C. The inner lining of the eyelid is reunited with sutures.
D. An ellipse of skin and muscle is removed from the outer corner of the eyelid.
E. Plication sutures unite the muscle to the tissue over the bone to tighten the lower eyelid skin.
Illustrations are from Dr. Putterman's textbook "Cosmetic Oculoplastic Surgery".

Details of Surgical Technique for Fat Repositioning

A. The lower eyelid fat is isolated from an inside eyelid approach and is slid downward into the hollowed area over the upper cheekbone.
B. Sutures are placed into the fat and then out through the skin to hold the fat in place.  These sutures are removed after six days and scar tissue keeps the fat in the hollowed spaces.
Illustrations are from Dr. Putterman's textbook "Cosmetic Oculoplastic Surgery".