John J. Martin
John Martin M.D., USA
John J. Martin is a graduate of Williams College and Harvard Medical School. He did a residency in ophthalmology at the Wills Eye Hospital in Philadelphia, followed by a fellowship in ophthalmic plastic and reconstructive surgery at the Bascom Palmer Eye Institute in Miami. He is board certifi ed in ophthalmology, and is also board certifi ed in facial plastic surgery by the American Academy of Cosmetic Surgery. He is a fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery, the American Academy of Cosmetic Surgery, the International Society of Cosmetic Laser Surgery, and is a member of the American Academy of Facial Plastic and Reconstructive Surgery.
In the past, lower eyelid blepharoplasty involved the removal of the periocular fat pads. While this would initially result in a smoother appearance to the lids, it would also create a hollow appearance which could worsen with time. With aging, there is also a hollowing which can occur below the orbital fat pads called the tear trough. As this becomes more pronounced with aging, it creates a tired appearance to the eyes. An excellent way to help correct the tear trough and prevent any hollowing of the lower lids is with a fat repositioning blepharoplasty. In this procedure, the orbital fat pads are moved into the tear trough through a transconjunctival incision. Th e repositioned fat helps to re-establish volume throughout the lid, decreasing the wrinkles of the skin, and smoothing out the lidcheek junction. Th is can be done with the CO2 laser which helps to minimize bleeding and post-op edema and bruising. Methods: Patients presenting for lower eyelid blepharoplasty had a fat repositioning procedure performed with a CO2 laser. A pinch of skin was also removed, and either a lateral tightening suture or a canthoplasty were performed at the same time. Results: All patients had an excellent cosmetic result. Most patients experienced post-op edema and bruising, and some had chemosis. Th ese all issues were resolved over a 2-3 week period. Conclusion: Lower lid blepharoplasty with fat repositioning produces a much better cosmetic result than traditional fat excision surgery. Preserving the fat helps to maintain a full, young looking eyelid, with a smooth lid-cheek junction. Use of the CO2 laser makes the surgery faster and decreases intra-operative bleeding.