Surgical and Non-Surgical Treatment of the Lower Eyelid Fat Bulging Using Lasers and Other Energy-Based Devices

Abstract

Lower eyelid fat bulging is a clinically evident sign of aging. Traditionally, surgical lower blepharoplasty has been used to improve this condition but the side effects and downtime have limited its use. This review summarizes the clinical manifestations, pathophysiology, and related anatomy of lower eyelid fat bulging; describes various surgical and nonsurgical alternatives to conventional open blepharoplasty; and determines the evidence-based efficacy of these procedures. The results have been favorable for the use of surgical lasers during transconjunctival lower blepharoplasty, but most non-surgical procedures lack scientific evidence despite non-invasive energy devices being safe, tolerable, and effective tools for periorbital skin rejuvenation. The data suggests that non-invasive devices should serve as an alternative, but not an equivalent substitute for surgery.