This is a 60 year-old female who presented to the office with complaints of excess skin of her upper and lower eyelids, dark circles under her eyes with prominent lower eyelid bags. We discussed her options for treatment which included: bilateral upper eyelid lifts (upper blepharoplasties) with removal of excess skin, bilateral lower eyelid lifts (lower eyelid blepharoplasties) with removal of skin via a subciliary incision and a skin flap, removal of the fat pads of the lower eyelids via a transconjunctival incision with release of the arcus marginalis to address the dark circles under the eyes, the dark circles were also treated with nanofat injection of the tear trough deformity (dark circles) and microfat grafting to the upper cheeks and lid cheek interface. This would all be done under local anesthesia in our office-based operating room with oral sedation and hyaluronidase in the local anesthesia to improve its effectiveness. The patient tolerated the procedure well under local anesthesia with harvesting of the fat from around her belly button area. The fat was processed into nanofat and microfat after straining it through a 400 um filter. The sutures were removed at postoperative day number five. A laser resurfacing of the lower eyelid skin was performed after 3 months to improve the lower eyelid skin texture. The patient was pleased with the improvement in the upper and lower eyelid appearance and resolution of the dark circles under the eyes.
