<Lower Blepharoplasty Part 3> Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once...

Hello~

I am Kim Seong-hoon, a board-certified plastic surgeon and facial designer.

Today, I will discuss the ultimate lower blepharoplasty procedure: fat repositioning + septal reinforcement + midface lifting. As mentioned in previous posts, the results of lower blepharoplasty (under-eye surgery) are as follows:

▶Fillers, fat grafting

→ May improve or worsen

▶Fat removal only

→ 100% recurrence or complications

▶Fat repositioning only

→ Low surgical satisfaction

▶Fat repositioning + septal reinforcement + midface lifting (± small amount of fat removal if necessary)

→ Long-term improvement and high satisfaction

Let me explain why these three procedures (fat repositioning, septal reinforcement, and midface lifting) must be performed simultaneously for optimal improvement, using a surgical diagram.

1. Incision

A skin incision is made close to the lower eyelashes. The reason for not making an inner conjunctival incision is to remove a portion of the sagging skin. For younger patients, a conjunctival incision is also possible.

Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once... — Skin incision directly below the eyelashes (conjunctival incision also possible)

2. Tear Trough Ligament Dissection

The tear trough ligament, which forms the tear trough, is dissected and released. Releasing it allows the pulled skin to detach from the ligament, eliminating the hollow appearance of the tear trough. This is the most crucial point in this surgery; it is no exaggeration to say that the surgery is performed primarily for this step.

Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once... 사진 2 — The tear trough ligament (white dotted line) is dissected.

3. Fat Repositioning

Protruding fat is repositioned towards the tear trough to create a smooth curve of the lower eyelid. At this time, excessive fat may be partially removed.

Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once... 사진 3 — Protruding fat is repositioned towards the sunken tear trough.

4. Septal Reinforcement

By tightening and reinforcing the stretched septum, the fundamental cause of fat protrusion is addressed, and recurrence (fat bulging again) is prevented.

Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once... 사진 4 — Cross-section of the lower eyelid (the stretched septum is made taut)

5. Midface Lift

The sagging midface, which has descended, is lifted and pulled upwards. If the midface appears sunken, the under-eye area can look aged, and simply repositioning under-eye fat alone will leave a 2% deficit in the result.

Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once... 사진 5 — The sagging midface is lifted.

6. Aegyo-sal Restoration and Enhancement

Finally, to prevent ectropion, where the eyelid turns outward revealing the red inner lining, and to restore the plump ‘aegyo-sal’ (under-eye fat roll) from youth. The orbicularis oculi muscle is pulled up and fixed to the bone.

Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once... 사진 6 — The orbicularis oculi muscle is reinforced.

7. Excision and Suture of Excess Skin

A portion of the sagging skin is removed to improve fine wrinkles, and the incision is meticulously sutured to minimize visible scarring.

Fat Repositioning + Septal Reinforcement + Midface Lift: All Done Properly at Once... 사진 7 — A portion of the sagging skin is removed, then sutured.

Simply removing protruding fat under the eyes without careful consideration cannot provide a fundamental solution. Always considering the cause and effect when performing surgery will lead to a choice without regret.

I will strive to be a plastic surgeon who operates without falsehoods or exaggerations.

Thank you.

1. Kakao Plus Friend

https://pf.kakao.com/_exfHsxb

2. Website

http://www.ksh-ps.com/index.php

3. E-mail

ps-severus@naver.com