Removal of orbital fat is a common maneuver during double eyelid surgery, and most textbooks list it as an integral step. In our experience, however, excising fat does not serve to "beautify" the Asian upper eyelid and is seldom indicated.
In general, patients seeking double eyelid surgery to create or enhance a weak crease are not just young but often very young. Aging tendencies have not yet made an appearance. Treating young lids in a "subtractive" manner (as is done in European "blepharoplasty" performed on older Occidental patients) makes little sense.
Incisional double eyelid surgery requires only a structural rearrangement of internal tissues to create a permanent crease. A tiny amount of closing muscle and orbital septum do need to be trimmed.
Fat removal, however, is not usually necessary.
Inappropriate or excessive orbital fat removal in a young Asian patient can lead to both immediate and late-term consequences:
• Crease too high
• Crease too deep
• Crease too rounded
• Crease multiplied
• Unnatural appearance
Spontaneous periorbital fat loss during middle age in common in many Asian lids.
Compounding such upcoming and unavoidable deflation with aggressive fat removal during double eyelid surgery at a younger age is like adding insult to injury.