Periocular rejuvenation: lower eyelid blepharoplasty with fat repositioning and the suborbicularis oculi fat.

Treatment of the aging lower eyelid is determined by the anatomic variables noted for each surgical candidate. Although surgeons have traditionally considered dermatochalasis, fat pseudoherniation, and eyelid position as the main treatment objectives in lower blepharoplasty, the vector of the infraorbital rim and the anterior plane of the cornea, tear trough, and aging in the midface also merit critical consideration. In this article, indications and technical aspects, the transconjunctival and external approaches, fat excision versus fat repositioning, and suborbicularis oculi fat lifting and fat transplantation are discussed and the authors' preference for the various methods of lower blepharoplasty is presented. Common adjunct procedures used to supplement lower blepharoplasty techniques and the role of injectable fillers in periocular rejuvenation are also mentioned.