There are three pockets of fat in the lower eyelid, the lateral fat pocket, the central fat pocket, and the medial fat pocket. These pockets of fat are separated by orbital septae and are removed separately during the procedure one by one.
In the case below (which is being done under local anesthesia), the skin and muscle has been elevated off the very thinned out orbital septum, showing the fat pockets clearly. Gentle pressure on the globe will make these bulge out even more to demonstrate that effect.
Some of the fat may be repositioned downard, to act as a filler in the tear trough deformity which is well exposed. This helps hide the orbital rim and blunt the separation from the eyelid area and the midface area, which, as we age, become more evident as separate regions because the midface descents, while the orbital fat bulges out, creating a hollow space in between along the orbital rim.
Dr. Khalifeh is dual board certified by both the American Board of Facial Plastic and Reconstructive surgery, as well as the American Board of Plastic Surgery.