Under-Eye Fat Repositioning

Fat that bulges below the eye is moved into the hollow of the tear trough rather than simply removed. With age the orbital septum — the membrane that holds the fat around the eye in place — weakens, and the fat pushes forward. The operation repositions that fat and tightens the septum, so the bulge and the groove beneath it are corrected together.

The incision is made on the inside of the lower eyelid, through the conjunctiva, so there is no visible external scar and no stitches to remove. The orbicularis muscle is left untouched, which preserves the small fullness under the lash line (aegyo-sal). The repositioned fat is placed beneath the periosteum, the firmest layer available, and the loosened septum is fixed taut — which is what keeps the bulge from returning.

Where dark circles come from fat that has gathered and descended, repositioning addresses the cause. Where they are pigment, it does not, and that distinction is made at examination.

Who it suits

• Bulging lower lids with a groove beneathFat is moved into the hollow rather than removed.
• Dark circles caused by fat, not pigmentThe cause is confirmed at examination.
• Patients wanting no external scarThe approach is through the inside of the eyelid.

Questions