Explanation by Medical Professionals on Lower Eyelid Surgery for Middle age Wrinkles and Under Eye Fat Removal

Hello, I am Dr. Kwon Jun Seong, a plastic surgeon at ATOP Plastic Surgery.

As we age, various changes occur on our faces. Among these, the most concerning issues are the wrinkles around the eyes and the bulging fat beneath the eyes.

Today, I would like to explain lower eyelid surgery for middle ages, comparing before and after photos to address these issues.

Lower eyelid surgery is a procedure to improve sagging skin, wrinkles, and bulging fat under the eyes. It is one of the most commonly performed eye surgeries among middle-aged and older individuals, alongside upper eyelid surgery.

Although the surgery is limited to the area below the eyes, it has an overall rejuvenating effect, improving the general appearance and making one look younger.

The method of lower eyelid surgery varies depending on the individual's skin condition and signs of aging. If there is not severe skin sagging or fat protrusion and the volume of the cheeks is appropriate, the procedure for midlife lower eyelid surgery involves repositioning the protruding fat under the eyes and removing the excess skin.

In cases where there is severe protrusion of fat under the eyes, with aging causing the cheeks to sag and a lack of volume in the cheek area, it is necessary to perform a midface lift (SOOF lift) in conjunction with lower eyelid surgery. This combined approach helps to reinforce the volume in the cheek area.

SOOF stands for "suborbicularis oculi fat," which refers to the deep fat layer located beneath the orbicularis oculi muscle.

As we age, the volume of fat in the face decreases and begins to sag. The midface lift (SOOF lift) is a procedure performed alongside lower eyelid surgery.

It involves making a wider dissection to lift and secure the deep SOOF tissue upwards. As a result, the volume in the cheeks is restored, and the highlight of the cheekbones is enhanced, leading to an overall rejuvenation of the midface, not just the area under the eyes.

I will explain this with an example of an actual midlife lower eyelid surgery patient.

A female patient in her 60s visited to address the bulging fat under her eyes.

The fat is protruding, and the lower tear trough is deeply defined. The skin also has many fine wrinkles. From a 45-degree angle, it is noticeable that the area below the protruding fat under the eyes lacks volume and appears quite hollow.

To achieve better results, we performed midlife lower eyelid surgery (including fat repositioning and skin removal), a midface lift (SOOF lift), and outer canthal fixation.

Outer canthal fixation involves pulling and securing the skin and orbicularis oculi muscle at the outer canthus. This procedure helps prevent the eyelids from turning inward and smooths out fine wrinkles by tightening the muscles.

One month after midlife lower eyelid surgery, the changes are noticeable. The protruding fat under the eyes and the tear trough have been smoothed out. Before the surgery, there was no visible fat pad (aegyo-sal) under the eyes, but it has naturally appeared as the under-eye fat was addressed.

Since the skin and orbicularis oculi muscle were pulled and securely fixed at the outer canthus, there is no sign of eyelid eversion, and the eyelid margin is well-maintained.

From a 45-degree angle, the protruding fat under the eyes and the tear trough have been cleanly addressed, and the midface lift (SOOF lift) has lifted the cheeks, naturally restoring volume to the cheekbones.

The wrinkles under the eyes have been smoothed out and the volume has been replenished, making the appearance much more vibrant and youthful compared to before the surgery.

While middle age's lower eyelid surgery focuses on improving the area under the eyes, it is a cost-effective anti-aging procedure that also enhances the overall impression.

The surgical approach can vary slightly depending on the individual's skin condition, signs of aging, and facial contour.

Since the results can differ based on the surgical method, it is advisable to consult with a board-certified plastic surgeon to achieve the highest satisfaction with the results.