Fat Excision in Upper Blepharoplasty
The nasal fat pocket can sometimes be difficult to access, is more vascularized, and is more innervated than the rest of the preaponeurotic fat. Additional local anesthetic injected within the fat pocket during excision will improve patient comfort. A small Desmarres retractor can be used to retract the skin nasally and better expose the nasal fat. The nasal orbital septum is carefully opened and the nasal fat pocket exposed. While grasping the fat with forceps, the surrounding tissue is pushed posteriorly using cotton-tipped applicators. The nasal fat can then be carefully excised with small snips of Wescott scissors or using pin-point monopolar cautery. Hemostasis should be achieved before the fat retracts back into the orbit.