Prolapsing the Inferior Fat Pads and Fornix in Lower Blepharoplasty
The successful transconjunctival incision depends on adequate prolapse and exposure of the conjunctival fornix. The lower eyelid margin is retracted by the assistant with two fingers. Retraction of the lower eyelid margin requires that the pads of the assistant’s fingers be placed directly upon the eyelid margin itself in order to exert sufficient inferior traction. At the same time, ballottement of the globe so as to prolapse the fat and conjunctiva anteriorly. When performed successfully, a liberal horizontal roll of prolapsing fat and overlying conjunctiva will present itself reliably and visibly. The use of the titanium Khan-Jaeger plate enables the surgeon to ballottement of the globe posteriorly in order to prolapse the fat anteriorly while also protecting the globe. Ballottement can also be achieved with a cotton-tipped applicator on the metal contact lens.