Lower Lid Blepharoplasty with Fat Repositioning

In this surgical video, Dr. Martin Devoto performs lower lid blepharoplasty with fat repositioning. He begins by using a CO2 laser to make a conjunctival incision and places a traction suture in the conjunctiva and retractors. The dissection is then performed from the medial to temporal aspect in the pre-periosteal plane. It is important, he explains, to completely release all the adhesions in the pre-periosteal region for about 10 millimeters; use a Q-tip to release the last adhesion. Two independent pedicles are created by releasing the medial and central fat pockets. Dr. Devoto then inserts a 5-0 nylon suture 10 mm inferior to the mark at the tear trough and uses the needle to engage the fat pockets. He explains that the lateral fat pad can be excised when needed; transposition can increase the risk of postop chemosis. The final step is to stitch the periosteum of the upper lid incision.

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