This is a basic surgical maneuver in most upper eyelid blepharoplasties of almost any kind, whenever there exists a bulge or protrusion at the lower eyelid due to the excess of fat at the inner, the middle and the outer adipose packets.
Accessing the fat bags is made by means of either the lower eyelid skin and muscle resection technique or alternatively the transconjunctival approach, which exposes the orbital septum; once found a tear hole is made at the orbital septum and the fat pads are reached; each fat pad is wrapped in another fibrous sheath which is also opened; the adipose content is tractioned and separated from the surrounding structures of the upper orbital space; then each bag is clamped with a forceps at the suitable point of excess and trimmed; before the forceps is released the fatty stump is coagulated with electrocautery to prevent bleeding, and then it is released into the depth of the orbit.