Eyelid Surgery – Fat Presevation

Eyelid Surgery – Fat Preservation. Tristan McMullen is a specialist eye surgeon at Aurora Clinics. In this video he explains fat preservation. For more information please visit our Eye Lid Correction information page or ring 01844 214362 and speak to a fully qualified patient advisor.

Eyelid Surgery – Fat Preservation

Hello. My name’s Tristan McMullan. I’m a consulting eye surgeon. I specialise in surgery in and around the eye and the face both for functional and cosmetic reasons. I’ve been asked to talk about fat preservation or conservation with regard to cosmetic surgery.

There was a vogue in the past for removal of fat. The thinking on this has changed to the point that now it’s appreciated that if you take away fullness, if you take away volume, you’re accelerating what is an aging change. A baby’s face is nice and full, whereas a very elderly person’s face tends to look rather gaunt and skeletonised due to tissue loss. This is both tissue loss relating to fat loss and thinning and wrinkling and stretching of the skin. Obviously, gravity plays an important part in this.

You’re probably aware that there’s been a big surge in the use of fillers in and around the face and elsewhere in the body. This is to replace volume. The logic of removing fat has gone out the window. Now we tend to preserve it as much as possible. If we’re going to take fat, it tends to be replaced.

In the upper lid, there is a small area of fullness that can become prominent with age at the inner corners. This is about the only place where I would remove fat. Otherwise I would conserve it or move it. There’s a phenomenon with facial aging where you get what’s called a tear trough which is really due to mid-facial descent and loosening of tissue that holds the normal fat back.

When we see people with fat in their lower lids, this is normal fat that has just become more prominent. The way that I would treat that would be to redrape that fat into the tear trough to hide the hollow between the bulge of the cheek and the bulge of the lower eyelid and remove that hollow by replacing the bulgy fat here into that hollow.

It would be dishonest to say you don’t remove any fat, but there’s certainly a move or a tendency to maintain that rather than remove it. Obviously, you have to treat each patient differently and assess their needs. But many, many patients just need a little bit of fat removal, if any, and replacement rather than removal. There will, of course, be some patients that do need some fat to be removed, but they tend to be the exception rather than the rule.

Similarly, when one’s talking about volume in the eyelids, there use to be a vogue for removing skin and the underlying muscle from the upper eyelid to remove the so-called excess skin or eye bags. Nowadays, what we tend to do is remove the skin and then bunch the muscle up underneath it. The skin is shortened but the underlying tissue is kind of concertinaed and wrunkled up to make a nice full appearance.

That’s a youthful look that patients wish to regain when they’re embarking on eyelid surgery. The other consequence of that is you’re not removing the muscle that closes the eye which then reduces the chances of them getting dry eye symptoms, particularly if these are pre-existing. So it’s kind of a win-win situation. Similarly in the lower eyelids, one tends to try and preserve the muscle as well. That’s another topic for another talk. Thank you.