The malar bag is not fat.
Nor is a ptosis an excess of skin, nor nanofat a filling product. Twenty-five words of eye surgery, defined by the surgeon who uses them. And for six of them, the video in which they are explained.
Dr Bernard Hayot · ophthalmologist, former Chief of Clinic, trained in oculoplastic surgery. Thirty years of microsurgery, devoted to the eyes and the eyelids. Paris 8e · RPPS 10003926226.
On the cheekbone, not under the eye.
It is a swelling situated lower down, opposite the malar bone, and of a different nature: not fat, but a lymphatic oedema linked to a slowing of the drainage.
What that changesOne must know how to tighten the orbicularis muscle by a sub-muscular lift, and to combine it with a micro-lipostructure that will surround the malar bag in order to mask it.
A problem of muscle, not of skin.
What is thought to be a difference between the two eyelids is in reality, most often, an asymmetry of the eyebrows. The eyelid and the eyebrow form a single anatomical unit: the frontalis muscle raises the eyebrow to compensate, but it is the eyelid that is descending.
What that changesThe trap? Treating the eyebrow without having diagnosed the ptosis.
Not a filling product.
It is a living cellular suspension, rich in mesenchymal stem cells and in growth factors. Injected into the dermis, it stimulates tissue regeneration, revives the microcirculation and improves the quality of the collagen.
What that changesIt is used to repair weakened skin: pigmented areas under the eyes, fine lines, loss of elasticity.
The deep tissues, not the skin.
Unlike classic cervico-facial lifts which pull on the skin, the deep plane repositions the tissues in depth, beneath the muscular plane. This technique does not stretch the skin: it restores the structure.
What that changesThe face remains expressive, alive.
Several excesses combined.
At the upper eyelid, too much skin and muscle was removed without taking into account the fat atrophy specific to this region. At the lower eyelids, the removal of the bags was too aggressive, likewise without taking into account the treatment of the hollow tear trough.
What that changesIt is one of the main indications for restoration by lipostructure: giving back the volume that was removed.
What is injected must be able to be removed.
One of the only advantages of hyaluronic acid is that it can be entirely removed thanks to an antidote: hyaluronidase. It dissolves hyaluronic acid when it does not resorb, or when the injection has been excessive.
What that changesThat is what makes this product acceptable, and what causes all the others to be set aside.
The twenty-five words
Each term, its definition, in the words of Dr Hayot.
The eyes
Blepharoplasty
Blepharoplasty is the surgery of the eyelids. It corrects the excess of skin and the fatty bags that weigh the eyes down. It may be upper, lower, or both.
Classic blepharoplasty
Classic blepharoplasty is the historical technique, by the cutaneous approach, centred on the removal of skin and fat. It lightens the eyes but, if badly measured, it can hollow them by removing too much volume.
Transconjunctival blepharoplasty
Transconjunctival blepharoplasty is a surgery of the eyelids by the internal approach, without a visible cutaneous scar. Combined with the CO₂ laser, it treats the bags and the quality of the skin of the eyes, without removing volume to excess.
Ptosis
Ptosis is the drooping of the upper eyelid linked to a failing levator muscle. To be distinguished from an excess of skin: ptosis is a problem of muscle, not of skin, and its correction is different.
Canthopexy
Canthopexy is the repositioning and the fixation of the outer corner of the eye, without dividing it. It firms and straightens the eyes. Canthoplasty, more invasive, divides the tendon, and is reserved for precise indications.
Malar bag
Also: malar oedema, malar festoonsContrary to a widespread idea, the malar bag is not a bag of fat under the eyes. It is a swelling situated lower down, opposite the malar bone (the cheekbone), and of a different nature: not fat, but a lymphatic oedema linked to a slowing of the drainage. This distinction is essential, because the malar bag is not treated in the same way at all as a fatty palpebral bag.
After surgery
Postoperative hollow eye
Also: post-blepharoplasty hollow eyeThe hollow eye occurring after a blepharoplasty that was too aggressive results from several excesses combined. At the upper eyelid, too much skin and muscle was removed without taking into account the fat atrophy specific to this region. At the lower eyelids, the removal of the bags was too aggressive, likewise without taking into account the treatment of the hollow tear trough. It is one of the main indications for restoration by lipostructure: giving back the volume that was removed.
Postoperative round eye
Also: scleral showThe round eye occurs above all after classic blepharoplasties, that is to say by the anterior approach at the level of the lower eyelid. It manifests itself by a scleral show: the appearance of white (sclera) visible between the cornea and the lower eyelid in the primary position of gaze.
Lagophthalmos
Lagophthalmos is the impossibility of closing the eye completely, manifesting itself above all at night. It appears after a blepharoplasty that was likewise too aggressive.
Ectropion
Ectropion represents the extreme case of complication after blepharoplasty: the eyelid is everted (turned towards the outside) and no longer touches the eyeball. It thus loses its function of protection, which leads to numerous ophthalmological symptoms: watering, irritation, and so on.
Postoperative dry eye
Dry eye after blepharoplasty occurs above all after an upper blepharoplasty, when there was a pre-existing dry eye syndrome that was not compensated for by adequate treatments postoperatively.
Fat
Lipostructure
Lipostructure is a technique of restoration by autologous fat. Your own adipose tissue is harvested, prepared and reinjected in order to give back the volume that has been lost. A living material, biocompatible, durable.
Defibrosing
The defibrosing of the fat is an essential stage of microlipostructure. It consists in removing the fibrous membranes that surround the adipocytes. This fibrosis is in a way the enemy of lipostructure: it blocks the cannulas and prevents passage through microcannulas, hence the term microlipostructure. Above all, it is often responsible for indurated cysts postoperatively.
Microfat
Microfat is fat that has been defibrosed, then passed through a microcannula in order to obtain fine particles intended to restore volume. It integrates into the deep planes of the face.
Nanofat
Nanofat is fat that has been fragmented and filtered, devoid of volume but rich in regenerating elements. It does not fill: it improves the quality of the skin, the texture, the pigmentation.
Stromal vascular fraction (SVF)
The stromal vascular fraction is a concentrate of regenerative cells derived from adipose tissue. It supports the integration of the fat and the quality of the tissue.
The face
Deep plane
The deep plane is a lift acting beneath the muscle, on the true supporting planes of the face. It repositions the tissues in depth, without cutaneous tension. To be distinguished from the lift by traction of the skin, which is more superficial and less durable.
Frontal endoscopy
Frontal endoscopy is an approach to the forehead and the eyebrow through mini-incisions, under video control. It makes it possible to reposition the eyebrow and the outer corner with a minimum of scars.
Injectables
Reversibility
What is injected must be able to be removed. That is the rule that governs the choice of products: hyaluronic acid is retained because hyaluronidase makes it possible to dissolve it. Non-reversible products are set aside, not for their efficacy but because they leave no possible way back.
Hyaluronic acid
Hyaluronic acid is the only synthetic injectable product that I use, because it is reversible by hyaluronidase. It restores volume temporarily. What is injected must be able to be removed.
Hyaluronidase
Hyaluronidase is the enzyme that dissolves hyaluronic acid. It is what makes this product reversible, and therefore acceptable. In the event of excess or of an accident, it makes it possible to go back.
Poly-L-lactic acid
Poly-L-lactic acid is a synthetic product stimulating the formation of collagen. I do not use it: it is not reversible and can expose the patient to an inflammatory foreign-body reaction and to fibrous encapsulation.
Calcium hydroxyapatite
Calcium hydroxyapatite is a synthetic volumising product, non-reversible. I do not use it, for the same reasons: risk of an inflammatory foreign-body response and of fibrous encapsulation.
Technologies
CO₂ laser
The CO₂ laser is the one that I use to treat the quality of the skin: fine wrinkles, laxity, texture. Combined with transconjunctival blepharoplasty, it resurfaces the skin of the eyelids without a cutaneous scar. It acts on the envelope, whereas fat restores volume, and the two procedures complement each other.
Microneedling radiofrequency
Microneedling radiofrequency is effective on certain skin indications. It is not a surgical substitute, and its excessive use can expose the patient to fat atrophy and to fibrosis.
This glossary grows richer over the course of consultations. It has an educational purpose and does not replace medical advice: every indication is judged on examination.