Overview
With age, the bone around the eye shows more clearly than the rest of the face, where thicker tissue still covers the bone. Standard lower eyelid surgery that removes fat can leave a hollow lower lid and an "operated" look. The author describes a technique that releases the arcus marginalis and advances the lower eyelid fat over the orbital rim, under the repositioned orbicularis muscle.
Findings
- Conventional lower blepharoplasty that removes lower eyelid fat can create a concave lower eyelid and an "operated" appearance.
- Technique: release of the arcus marginalis; the fat behind the septum is advanced and sutured beyond the entire lower orbital rim, under the repositioned orbicularis muscle.
- Covering the lower orbital rim makes midface rejuvenation more complete, per the author.
- 152 cases over 3 years, with "impressive results and minimal complications."
- The procedure is done in all of the author's composite rhytidectomies and in isolated blepharoplasty patients without advanced facial aging.
- It is indicated in particular for revision surgery after too much orbital fat was removed, or after deformities from cheek augmentation.
What it means for a patient
- If you are having a facelift with lower eyelid surgery, ask whether your surgeon removes lower eyelid fat or repositions it.
- Removing too much lower lid fat can leave a hollow, "operated" look. Repositioning the fat over the bony rim aims to hide the rim.
- The technique is also used to correct hollowing from earlier eyelid surgery.
- Results are the author's description of 152 cases. The abstract gives no complication rates.
Why this paper matters
It presented fat preservation and repositioning as an alternative to fat removal in lower eyelid surgery, performed together with midface and composite facelift work. Cited 258 times (NIH iCite, 2026-09-25).
Terms
- Arcus marginalis: the fibrous edge where the eyelid septum attaches along the bony rim of the eye socket.
- Orbital rim (infraorbital rim): the bony edge below the eye.
- Lower blepharoplasty: lower eyelid surgery.
- Subseptal fat: the fat pads behind the thin membrane (septum) of the lower eyelid.
- Orbicularis muscle: the ring-shaped muscle around the eye.
- Midface: the area between the lower eyelids and the upper lip, including the cheeks.
- Malar augmentation: adding volume to the cheekbones, for example with implants.
- Composite rhytidectomy: a facelift that lifts skin, fat and muscle together as one flap.