This is a very common procedure. It is performed fog baggy upper and/or lower eyelids. The lower lid has three compartments. Outside, Inside and middle. The outside is correctly termed lateral. The inside is correctly termed medial or nasal. The middle is often called the central compartment. The overwhelming majority of surgeons make an incision just below the lower eyelashes. This incision goes thru the skin and the muscle to gain access to the fat compartments. This muscle is extremely delicate. Complications affecting this muscle can retract the lid and leave the eyeball exposed.
Exposure of an eyeball is a medical emergency. Fortunately this is uncommon. I prefer the internal approach. I turn the lower eyelid inside out and I go through there to access the fat and avoid contact with the muscle. With this approach the lateral compartment is most frequently missed. At the end of surgery no stitches are necessary because this specialized tissue is self-healing and does so without a scar. For those of you that like to look stuff up; this internal approach is called Transconjunctival, the fold is called the epicanthal fold, the crease the supratarsal crease and the extra fat is periorbital fat. This procedure subtracts 5 -20 years off of the appearance. It is very frustrating to look tired when you are not. These people are happy and look refreshed. I have been using the internal approach for nearly 20 years. I read recently that it was a new and revolutionary procedure. I don’t know if I need more marketing or they need more experience.
The procedure for the upper lids is pretty straight forward. An incision is made and hidden in the natural upper lid crease. The upper lids have 2 compartments. The surgeon carefully dissects the structures and removes the excess fat from both compartments. The medial or nasal compartment in the upper lid is the most commonly missed. If you remove too much fat then the person gets that sunken appearance. That is not attractive. Many people have excess skin in the upper lid and this can removed with the same incision made to extract the fat.
Depending on their age removal of excess skin may only be temporary. Gravity on the aging forehead and brow can cause excess upper lid skin. A forehead lift is the solution for that problem. For now, we just want to extract the fat and close the wound with stitches.