Learn about Eyelid Surgery: The trend towards fat preservation
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Hello! My name is Tristan McMullen. I am a consultant eye surgeon and I specialize in surgery, in and around the eye and the face, both the functional and cosmetic reasons. And I have been asked to talk about fat preservation or conservation with regard to cosmetic surgery. There was a vogue in the past, for a movement of fat. But the thinking on this has changed to the point that now, it's appreciated that, if you take away fullness, if you take away volume, you are accelerating what is an aging change. A baby's face is nice and full whereas a very elderly person's face tends to look rather grown and skeletonize due to tissue loss and this is both tissue loss relating to fat loss and thinning and wrinkling and stretching of the skin and obviously, gravity plays an important part in this. And you're probably aware that there has been a big surgeon that used fillers in and around the face and elsewhere in the body, and this is to replace volume. And so the logic of removing fat has gone out the window and now, we tend to preserve it as much as possible and if we're going to take fat, it tends to be replaced. So, in the upper lid, there is a small area, the fullness that can become prominent with age, at the inner corners and this is about the any place where I would remove fat, otherwise I would conserve it or remove it. And there's a phenomenon with facial aging where you get was called the tear trough, which is really due to mid-facial descent and loosening of the tissue that holds the normal fat back. So when we see people with fat in their lower lips, this is normal fat, that has just become more prominent, and the way that I would treat that would be to redrape that fat into the tear trough to hide the hollow between the bulge of the cheek and the bulge of the lower eyelid and remove that hollow by replacing the bulgy fat here, into that hollow. It would be dishonest to say you don't ruin any fat, but there's certainly a move or a tendency to maintain that, rather than remove it. And obviously, you have to treat each patient differently and assess their needs. But many, many patients just need a little bit of fat removal if any, and replacement rather than removal. There will of course be some patients that do need some fat to be removed, but they tend to be the exception rather than the rule. Similarly, when one is talking about volume in the eyelids, there used to be a vogue for removing skin and the underlying muscle from the upper eyelid and to remove the so called excess skin or eye bags. But nowadays, what we tend to do remove the skin and then bunch the muscle up underneath it, so that the skin is shortened, but the underlying tissue is kind runkled up to make a nice, full appearance and that's a useful look of the patients wish to regain, when they are embarking on eyelid surgery. And the other consequence of that is that, you are not removing the muscle that closes your eye, which then reduces the chances and getting dry eye symptoms particularly, if these are preexisting. So it's a kind of win-win situation and similarly, in the lower eyelids, one tends to try and preserve the muscle as well, but that's another topic for another talk. Thank you.
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