Medial Fat Pad Resection during Upper Blepharoplasty

It is very common for me to resect medial fat during an upper blepharoplasty.  I usually preserve preaponeurotic fat, unless there is significant expansion.  If the medial fat is difficult to expose and mobilize, I will be less likely to resect it.  There is a risk of causing a hemorrhage that can be difficult to control in resecting the medial fat, and a retrobulbar hemorrhage could potentially occur if significant tension is placed on the fat. 

This is Richard Allen at oculosurg.com.  This video demonstrates exposure, mobilization, and resection of the upper medial fat pad during an upper eyelid blepharoplasty.  The orbital septum is identified medially and opened with the needle tip cautery.   A cotton tip applicator is then used to expose and mobilize the medial fat.  The medial fat pad can sometimes be closely associated with the preaponeurotic fat.  The medial fat is usually a lighter yellow or even white, while the preaponeurotic fat is a darker yellow.  The fat pad is gently mobilized and this can be uncomfortable for the patient.  It is then injected with local anesthetic.  I use the monopolar cautery on coagulation mode to resect portions of the fat pad.  If additional fat easily prolapses forward, it is resected as well.  One can placed gentle pressure on the globe or lower lid to help prolapse additional fat forward.  Hemostasis is then assured with the needle tip cautery.