The Stab Incision Procedure for Upper Eyelid Medial Fat Pad Removal

Abstract

Introduction:

Traditionally, surgeons have made a horizontal incision the entire length of the upper eyelid to reach the medial fat pad and remove it. Performing that incision and subsequent dissection bilaterally is a time-consuming procedure. Merely performing a 3- to 4-mm oblique stab incision to gain direct, immediate access to the medial fat pad for removal is a safe, time-efficient, minimally invasive procedure with a far smaller scar.

Materials and Methods:

Under local anesthesia, a no. 11 blade is used to perform the 3- to 4-mm stab incision through skin, muscle, and septum to gain access to the medial fat pad. The fat pad is meticulously and gingerly teased out using cotton tip applications, and a hemostat to spread tissues and clamp excessive fat for excision and cauterization. The skin is closed with interrupted 6–0 nylon sutures.

Results:

The authors have performed 979 of these procedures (bilateral) with extremely high patient satisfaction rates during a 10-year period. A total of 15 patients requested more medial fat to be removed. Intralesional steroids were used in 10 patients to treat mild hypertrophic scarring where the incision site was made, which favorably resolved. The average length of time of the procedure was less than 15 minutes.

Conclusions:

The stab incision procedure for upper medial fat pad removal is a safe, effective, and more time-efficient procedure when only removing the medial fat pad than the traditional upper blepharoplasty.