The Fat Has It – Especially For Our Eyes!

Written by Frank P. Fechner, MD

Before and After Photo of Young Man after Advanced Lower Blepharoplasty

“The eyes are the mirror of the soul!”
This saying reflects the importance we put on the eyes when looking at people. And it is not only the eyes themselves; rather their appearance is substantially influenced by the surrounding facial regions including the under eye area. This underlines why cosmetic eyelid is so important and popular: it supports the attractiveness of the eyes without “changing” who we are.

Commonly, patients come to see me concerned with dark under eye circles and puffy lower eyelids. Although the reasons maybe multifold, frequently this is due to two confounding factors: excess fat right within the lower lids and a deficit of fat (or bone) right where the eyelids join the cheeks. This creates a groove, commonly referred to as “tear trough”, which allows shadows to cast – often made worse in certain indirect lighting situations.

Only if we understand the underlying problems can we design and plan an appropriate treatment. Best results can be achieved if the puffiness is reduced AND the hollowness is filled. Although done by plastic surgeons for decades, it is rarely advisable to only remove all the fat because it leads to a haggard look with hollow eyes.

As part of the eyelid lift we like to fill the tear trough using the patient’s own fat. This can be done with facial fat grafting where we take the fat from areas of excess (i.e. stomach or hips). Or, how about using the the eyelid fat that we want to remove and simply reposition it lower to achieve the desired plumping effect?

This is what we did for the gentleman shown in the photographs: we precisely re-distributed the under-eye fat tissues to achieve a softer transition from the cheeks to the lower lids. Although it takes more time to perform this advanced lower blepharoplasty procedure, the end result makes the extra effort certainly worth it!