The enhancement of the region around the eyes has attracted the most concern even from the early days of facial plastic surgery, since this is the area that is most likely to betray one’s real age.
Most patients believe that they have too much skin on the upper eyelids and thus techniques have focused on tightening the skin on the upper eyelids. The weary facial expression of the eye region is mostly caused by a sunken eyebrow area and thus a brow lift has been integrated into the treatment concept.
This situation is mimicked to the lower lids.
There are increasingly intricate techniques for tightening the skin, ligament reconstruction for the ring muscles around the eyes to avoid hanging eyelids and techniques for the removal of lower eyelid fat, the so-called "bags".

A technique has recently been introduced that addresses the reconstruction of facial layers of fat. The ageing process indeed leads to drooping skin and wrinkles, but also to the reduction of fatty tissue in the face.
The bone construction droops further and the face presents a "harder" appearance. One may clearly recognise this effect around the eyes, where the bone under the eyebrows droops and the "bags" further below, than would otherwise be the case in a younger face.

The new technique addresses the rejuvenation of the eye region by combining a skin lift (blepharoplasty), injecting fat below the eyebrows, the lateral upper eyelid and below the "bags", where it has become depleted over time.
The injection of fat often makes the tightening of the skin redundant. A particularly gentle technique is employed in this fat repositioning, whereby the fat cells are left intact so that they may grow at the projected areas around the eye.
There is always sufficient fatty tissue available at the donor sites that are usually the hips or the inside of the knee. Only small amounts of fat are required so no permanent changes may be expected to these donor sites.

During the correction, incisions are made in such a way that they are parallel to the eyelid and run within the skin folds. The excess tissue is removed and the margins around the wound are finely sutured so that no scars are visible when the eye is open.
Injections of fat are then made where necessary or desired by the patient. The restoration of fatty deposits significantly aids the rejuvenating effect of blepharoplasty.

Even lower eyelid retraction requires careful analysis of change during consultation. Usually it is a matter of slackening the skin, musculature and pushing the fatty deposits below the eyeball. The therapy is guided by the degree that the individual components are pronounced.
Lower eyelid retraction is often performed in concert with upper eyelid elevation, though may be performed alone.

Where the skin is taut and the musculature even tauter, pure fatty tissue may be removed through the conjunctival sac without any visible scar. This is often the case with younger people.
The incision runs below the eyelashes and to the side of the laugh lines when both the skin and muscles are taut. These scars are barely visible after a short time.
The ring muscle that is attached to the eye socket bone with 2 sutures bears the main tension of the contoured lower lid.
The skin suture itself is completely free of tension.
An injection of fat may be performed during surgery when fat is missing on the bone or cheek bone. The need for this is also identified during the pre-operative consultation.

You should bring a pair of sunglasses to the operation as bruising and swelling is likely to last for approximately 10 days.
It is advisable to rest and cool the eye region for a couple of days after the operation. Massage and lymphatic drainage for several weeks may aid the healing process.