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Dr. Leber has a very unique approach to lower eyelid rejuvenation. The traditional method of lower lid blepharoplasty would remove what appeared to be lower eyelid fat pockets. This has a fairly high complication rate including lower lid malposition with subsequent dry eye and potential unnatural scleral show (white of the eye showing below the pupil). With the introduction of facial fat grafting our understanding of the aging process and methods of achieving facial rejuvenation have changed.

As we age we lose facial volume and appear more skeletal and deflated. The fat pockets within the orbit under the eyes become more noticeable with the loss of facial fat in the cheek and lower eyelid. The lower eyelid appears to elongate with a very noticeable hollow lid cheek junction at the lower orbital rim. Additionally, some of the remaining fat loses its support and descends lower in the face leading to prominent nasolabial folds and jowls. Traditional lower lid blepharoplasty removes some of the orbital fat pockets to reduce the bulging appearance. This can actually make a person look older by giving the eye a hollowed and more skeletal appearance and can sometime lead to lower eyelid malposition leading to an unnatural appearance.

Dr. Leber’s approach to lower eyelid rejuvenation (lower lid blepharoplasty) focuses on blending the lid cheek junction by adding volume to the hollow in the thin lid cheek junction below the orbital fat pockets. This is accomplished utilizing micro fat grafting technique with a blunt microcannula. Additionally, fat is often placed in the lateral cheek and tear trough region allowing volume restoration and blending of the lid cheek junction. The deflated skin envelope becomes re inflated helping to lift the nasolabial fold, making it look less prominent. A very small amount (2-3 mm) of redundant skin under the lash line is then removed and the underlying lax muscle (orbicularis oris) is tightened by anchoring it to the lateral orbital rim. Taking up the laxity in the muscle also helps further blend and smooth the lid-cheek junction, similar to pulling a lax bed sheet taught. The procedure is safe and has less complications than traditional lower lid blepharoplasty as the deep tissues (orbital fat pockets) are unaltered leading to less scaring, bleeding and bruising. Additionally, Dr. Leber can perform this procedure (pinch blepharoplasty and facial fat grafting), in his office under local anesthesia with little of no discomfort.

Utilizing your own fat for facial rejuvenation has additional benefits not provided with other fillers. Stem cells present in the grafted fat may lead to more youthful appearing overlying facial skin. In addition to adding volume, poor size is often reduced, fine lines look less prominent and the skin looks more youthful with less pigment irregularities and more reflective surface. These improvements can be clearly seen in many of my post-operative photos facial fat grafting photos.