Mobilizing and Excising the Nasal Fat Pad in Upper Blepharoplasty

Abstract

After the initial incision and removal of skin and muscle, bluntly spread the fascia over the nasal fat pad with a hemostat. Ballottement the globe will prolapse the fat pad forward. Make an “X”-shaped incision over the nasal fat pad, deepening the incision until the fat prolapses. Grasp the protruding knuckle of fat with forceps and use a cotton-tip applicator to bluntly strip away tissues retaining the nasal fat pad. Supplemental local anesthesia injection is usually required at the base of the nasal fat pad. The fat pad may be excised across a closed hemostat or divided using a laser against a backstop. Adequate hemostasis is important because of the caliber of vessels associated with the fat pocket.