Surgery to treat the aging lower eyelid has undergone significant evolution in the last decade. For years the treatment of lower lids amounted to just plucking fat out of the lower eyelids and removing a strip of skin. For more than 10 years now, I have looked at things differently. A major part of the visual effects of aging include the enhancement of the lid check interface tear trough deformity. My approach to treatment requires a lesson in aging so here it goes.
As we age our thicker cheek tissue stretches subtly away for the underlying bone. This allows this skin and fat to fall. As it falls it shows the demarcation between thin eyelid skin and thicker cheek skin and there is a hollow that reveals itself in this wake. Eventually, the covering over the eyelid fat pads thins out and shows as fat bags. If the skin is poor enough it too will sag down on top of the cheek.
So correction often necessitates a combination of skin removal, conservative fat removal, separation of lid cheek binding at bone level, fat transposition of extra eyelid fat over orbital rim and under lid cheek tear trough, and finally a lateral upper cheek lift to elevate the cheek mound back up to cover the orbital rim further. Check out examples of this technique on my web site- Spiro Plastic Surgery