Pack Your (Lower Eyelid) Bags: Surgical Correction of Lower Eyelid Bags with a Septal Reset

A Septal Reset is a component of a lower eyelid blepharoplasty, which is a surgical procedure to help rejuvenate the lower eyelid and cheek region. A septal reset is not part of every lower eyelid blepharoplasty and is designed for specific lower eyelid issues such as puffiness, bags and a deep tear trough.

Lower eyelid bags can reveal themselves early, sometimes in the twenties. A newborn baby will typically have lower eyelid bags which dissipate over the first days of life.

What causes lower eyelid bags?

Lower eyelid bags and puffiness can be associated with:

  • Flattened cheek area and deficient boney support in this area
  • Dense connection of the lower eyelid tissue to the orbital bone, called the arcus marginalis
  • Bulging lower eyelid fat pad, can increase the prominence of lower eyelid bags

Lower eyelid bags will typically worsen with age.

Moderate lower eyelid bags are not amenable to volumetric filling which only blends this line of demarcation.

Lid cheek junction is an important line of demarcation, which is accentuated and elongated with lower eyelid puffiness.

A septal reset can help to decrease lower eyelid bags by releasing the tight tissue junction at the orbital bone, repositioning fat from the orbit to fill the void of tissue over the bone. This tightens the septum and provides volume to the cheek.

Am I a candidate for a septal reset?

A septal reset should be performed selectively on patients seeking lower eyelid rejuvenation. Good candidates are healthy patients without pre-existing dry eye, with decreased cheek projection, a deep tear trough or tight arcus marginalis, and bulging or bagginess of the lower eyelids.

  • A septal reset is a component of a lower eyelid blepharoplasty and is combined with canthal support, orbicularis repositioning and skin excision.

The septal reset rejuvenates the lower eyelid cheek junction by repositioning the fat over the orbital rim and securing the orbital septum to the cheek.

Three Steps of a Septal Reset

  1. Release of the Arcus Marginalis
  2. Reposition of the orbital fat
  3. Tightening of the septum

The incision placement for a lower eyelid blepharoplasty is generally under the lash line, though it can be performed through the back of the eyelid (transconjunctival). The fat and septum are repositioned and tightened with internal sutures and then the orbicularis oculi muscle and cheek are lifted above the area of the septal reset.

Recovery from any open lower eyelid blepharoplasty procedure is approximately 2 to 3 weeks. A Septal Reset does not significantly prolong this period. Sutures are removed at the 4 day point. Eye care, with hydrating drops are recommended for 2 weeks. Bruising and swelling may be persistent for over one week.

Andrew P. Trussler MD is an experienced plastic surgeon in Austin Texas with advanced training in lower eyelid surgery including secondary correction of lower eyelid malposition, including ectropion and lower eyelid bags (festoons).

Dr. Trussler’s Austin Texas plastic surgery office can help guide you in correcting commonly seen lower eyelid aging complaints. A lower eyelid blepharoplasty with a septal reset can help your eyelids not only look better, but function better.

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