Tear Trough (Under Eye Hollows) Septal Reset Fat Transposition

As we age, we can start to notice changes to the lower eyelids and midface, which can include orbital fat, tear trough deformity and lid laxity.

This can be repaired or improved by a cosmetic eyelid surgical procedure performed by Dr. Hodgkinson that treats the redundant skin or orbital fat malposition. A lower eyelid blepharoplasty involving skin excision and the manipulation of inferior orbital fat pads can reposition or augment the area with dermal fillers, anti-wrinkle injections  or autologous fat grafts.

The ageing process often affects the lower eyelid and midface areas first. Repairs to these areas can help restore a youthful look to the eyelid and cheek, assisting a patient to give a less tired appearance.

Why am I starting to see issues with my under eye hollows?

As we age, the midface will likely descend, leading to displaced cheek fat and a tear trough deformity. This can create the look of bags or circles under the eyes, which gives you a chronically tired look. The most common causes for issues in the lower lid area are aging, excessive skin, lower lid laxity, herniated orbital fat, or tear trough deformities.

Determining the correct solution for addressing this will depend on the extent of herniated orbital fat, the amount of excess skin, appearance of midface volume loss, and a range of other factors that would be assessed during a consultation. There are several techniques that can address this, both noninvasive via the use of filler or lasers and invasive via the blepharoplasty procedure.

The exact approach will depend on your current situation, goals, and the knowledge and experience of Dr. Hodgkinson, who will work closely with you to determine the most beneficial path forward.

Tear Trough Septal Reset Fat Transposition
Before and After Upper Lid Blepharoplasty performed by Dr Hodgkinson

What is involved in the procedure, and are there different options?

The approach to dealing with the under-eye hollows may be either transcutaneous or transconjunctival. Dr. Hodgkinson will address your situation and decide which will be best suited to you. Essentially, the need for skin resection will be a deciding factor; however, both procedures will address herniated orbital fat and midface volume loss.

A common way to deal with this problem is via fat removal, repositioning, and augmentation with dermal fillers. Autologous fat grafting is also an option.

The transcutaneous approach

The transcutaneous lower lid blepharoplasty involves the skin flap or skin–muscle process. The skin flap involves an incision that is then elevated from which the area between the lower eyelid skin and the orbicularis muscle is removed. This allows for the removal of excess skin without disruption to the underlying muscle. The skin–muscle flap method is better suited to younger patients as it involves the trimming of the muscle.

The transcutaneous approach is best suited for patients with significant skin wrinkling.

Tear Trough Septal Reset Fat Transposition
This image demonstrates the various incision positions of the transcutaneous and transconjunctival approaches depending where it is required for the patient. Image ref: https://www2.aofoundation.org

The transconjunctival approach

The transconjunctival approach is the best option to reduce visible external scarring and is suitable for patients with little lid laxity but bulging fat. This approach allows for the fat to be manipulated by the surgeon. Orbital fat may be removed, repositioned, or augmented with an autologous fat transplant. It is essential to have a highly-skilled surgeon perform this procedure as the removal of too much fat may result in a more prominent tear trough or hollowed appearance.

Tear Trough Septal Reset Fat Transposition
Before and after of upper eyelid blepharoplasty performed by Dr. Hodgkinson.

Why is Dr. Hodgkinson the best surgeon for this procedure?

Dr. Hodgkinson is a sought-after cosmetic plastic surgery expert who has performed thousands of procedures over his thirty-year career. The knowledge, experience, and patient care that he brings to each procedure is unrivaled, especially when concerning eye and nose surgery.He assesses all situations, both aesthetically and in a practical sense to ensure the best outcome for his patients. Dr. Hodgkinson has also travelled the world as a guest lecturer on various facial cosmetic topics over the last 20 years.

When the aesthetics of tear troughs and under-eye regions are concerned, Dr. Hodgkinson is well-suited to the task in his capacity as an expert in customising eyelids. He operates with the primary goal of rectifying the patient’s concerns while also creating a natural look via a range of advanced techniques acquired over his many years of experience. Dr. Hodgkinson creates permanent results and restores a look similar to that of your younger years.

Tear Trough Septal Reset Fat Transposition
Dr. Hodgkinson is an expert in customising and refreshing the eyes to create a more natural look.

Dr. Darryl Hodgkinson is well known for spending a significant amount of time working with his patients prior to surgery to understand their wants and needs, in turn, creating an attractive and pleasing aesthetic. He believes that surgical outcomes should be customised to the physical features of the individual, and as a result, his patients experience complete satisfaction.

By establishing a positive relationship, Dr. Hodgkinson is not only able to create a comfortable environment for the patient, but also achieve the best possible results. This, combined with his in-depth skills, are the reason why he is so sought-after by people from all over the world. Patients know to trust the high quality of his work and are always given a positive experience by his whole highly-trained team.

Tear Trough Septal Reset Fat Transposition
Acquire a more youthful, refreshed look by removing excess skin that creates a tired appearance under the eyes.

Frequently Asked Questions

How long will the actual procedure take?

Length of time is often dependent on both the work required due to the scope of the issue as well as which of the above processes Dr. Hodgkinson decides is best for you. Most surgeries in the lower eye area can be performed on an outpatient basis with local anesthetic. We often state a rough time frame of one to two hours on average, and you will require someone to drive you home post-procedure.

How long will it take me to recover?

If your situation is indeed an outpatient surgery, you can return home later in the day once our team has assessed and determined it safe for you to do so. Generally, the wait time is to ensure the local anesthetic has worn off, and there are no complications.

The recovery time of the procedure itself will vary; however, full recovery is usually reached around 2-3 weeks post-procedure, but this may vary based upon the extent of the surgery and the healing abilities of the patient.

Will this procedure fix issues with my vision?

In cases where excess skin is causing issues with vision, there are other procedures that can be of benefit. It is, however, crucial that you have the causes of the problems assessed before determining that cosmetic surgery is the correct course of action, as it will not help in cases of glaucoma, occlusions, or a detached retina. If you are experiencing issues with your vision, we highly recommend you see an eye doctor for a diagnosis of the issue before looking into a cosmetic procedure.

tear through septal reset fat transposition

Dr. Hodgkinson aims to create a natural look, similar to that of a patient’s early 30s.

Is this considered to be a painful procedure?

Most versions of eyelid surgery are considered to be relatively comfortable. In the case where a patient has a low pain tolerance or is experiencing discomfort, panadol may be used to help. We can also recommend ice soaked eye pads as a way to reduce swelling post-operatively. Narcotics are never needed.

What side-effects should be aware of as a result of the surgery?

Post-procedure, swelling, bruising, or redness are all entirely normal and expected, and will settle naturally within a few days. Some patients may also experience watery eyes, which should also not be cause for alarm. Your recovery can be assisted by keeping your head elevated and using a cold compress, both actions that will help reduce swelling. Some cases may require eye drops or creams if there is significant discomfort. This information on the appropriate products will be given by our team if necessary.

Will this procedure be covered by health insurance?

It is unlikely that this form of eye surgery will be covered under an insurance policy as only those deemed medically necessary are eligible for a rebate. We will have a clearer idea about this during your consultation; however, in most cases, this request is for aesthetic improvements only. We will provide exact pricing for the procedure in your consultation, as well.

What do I do if I experience a problem after the procedure?

Dr. Hodgkinson and his in-depth support of his team, assures your safety during and after the operation. If you should have an issue during your aftercare process, the team is on-hand to assist you at any point.

Dr Darryl Hodgkinson

About Dr Darryl Hodgkinson

Dr. Darryl J. Hodgkinson is recognized world-wide as an expert in cosmetic plastic surgery with more than thirty years of experience in both cosmetic and plastic/reconstructive surgery.

Dr. Hodgkinson did his plastic surgical training at the prestigious Mayo Clinic in the United States and is amongst an elite group of a very few surgeons to hold two degrees in plastic surgery from American Board of Plastic and Reconstructive Surgeons and the Royal College of Surgeons, Canada.

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