Treating baggy lower eyelids typically involves straightforward transconjunctival fat removal. However, excessive fat removal can cause hollowing as a patient age, creating an aged appearance. The fat pad sliding method by Loeb and the "arcus marginalis release with preservation of orbital fat" method by Hamra have been reported as useful techniques to address tear trough deformities. Based on these methods, I present an orbicularis oculi muscle overlap method (Aesthetic Plast Surg 18: 648-652, 2014) that displays promising results, even in cases with deep nasojugal grooves.
For patients without considerable skin laxity, the transconjunctival fat repositioning technique reported by Goldberg is performed. This method offers minimal downtime and a reduced risk of ectropion as it doesn't involve skin incisions, making it suitable for a wide range of patients. For cases with noticeable fine skin wrinkles, the procedure solely includes skin excision (pinch blepharoplasty) in addition to the technique described above. While the fixation of repositioned fat is difficult with the transconjunctival approach, using the Cataran needle-guided thread induction method allows for secure fixation without thread pull-out. This presentation aims to report on these techniques using video illustrations.