Lower blepharoplasty with orbital fat repositioning technique through the transcutaneous and transconjunctival approach

In standard lower blepharoplasty, excess orbital fat is usually removed. However, over-excision of orbital fat may cause a skeletonized appearance. Loeb in 1981 described a new fat sliding technique for the nasojugal groove in lower blepharoplasty. Hamra developed this concept and reports it as a technique with an arcus marginalis release and orbital fat preservation. However, with the transcutaneous approach there is the possibility of scleral show. Goldberg reported a new technique of fat redistribution by a transconjunctival approach. By transferring the orbital fat across the infraorbital rim, a youthful lower eyelid with convexity could be created. The approach depends on the underlying pathologic process and what the patient and surgeon perceive as the underlying abnormality. The surgeon should be familiar with both approaches to the lower eyelid and attempt to adjust the surgical procedure according to the patient.