A malar pouch is not a pocket of fat.
Nor is ptosis excess skin, nor does nanofat fill anything. Twenty-five words of eyelid and periorbital surgery, defined by the surgeon who uses them.
Dr Bernard Hayot · ophthalmologist, former chef de clinique, trained in oculoplastic surgery. Thirty years of microsurgery, devoted to the eyelids and the periorbital region. Paris 8 · RPPS 10003926226.
The twenty-five words
Each term, defined in Dr Hayot's own words.
The gaze
Blepharoplasty
Eyelid surgery. It corrects the excess skin and fatty bags that weigh the gaze down. It may be upper, lower, or both.
Classic blepharoplasty
The historical, skin-approach technique, centered on removing skin and fat. It lightens the gaze but, poorly dosed, can hollow it by removing too much volume.
Post-operative hollow eye
The hollow eye that follows an overly aggressive blepharoplasty results from several combined excesses. At the upper eyelid, too much skin and muscle were removed without accounting for the fat loss specific to that region. At the lower eyelids, bag removal was too aggressive, and the hollow tear trough went untreated. It is one of the main indications for lipostructure restoration: giving back the volume that was taken.
Transconjunctival blepharoplasty
Eyelid surgery through an internal approach, with no visible skin scar. Combined with CO₂ laser, it treats under-eye bags and skin quality without removing volume in excess.
Ptosis
A drooping of the upper eyelid caused by a failing levator muscle. Distinct from excess skin: ptosis is a muscle problem, not a skin one, and its correction differs.
Canthopexy
Repositioning and fixation of the outer corner of the eye, without cutting it. It firms and lifts the gaze. Canthoplasty, more invasive, divides the tendon, reserved for specific indications.
Malar pouch
Contrary to a widespread belief, the malar pouch is not a pocket of fat under the eyes. It is a swelling situated lower, over the malar bone (the cheekbone), and of a different nature: not fat, but lymphatic oedema linked to slowed drainage. This distinction is essential, because a malar pouch is not treated at all in the same way as a fatty eyelid bag.
Lagophthalmos
Lagophthalmos is the inability to close the eye completely, most noticeable at night. It appears after a blepharoplasty that was, again, too aggressive.
Ectropion
Ectropion is the extreme case of complication after blepharoplasty: the eyelid is everted (turned outward) and no longer touches the globe. It loses its protective function, which brings a range of ophthalmic symptoms: watering, irritation, and others.
Post-operative dry eye
Dry eye after blepharoplasty occurs above all after an upper blepharoplasty, when a pre-existing dry eye syndrome was not compensated by adequate post-operative treatment.
Post-operative round eye
Round eye occurs above all after classic blepharoplasties, that is, through an anterior approach at the lower eyelid. It shows as scleral show: white sclera becoming visible between the cornea and the lower eyelid in primary gaze.
Fat and its preparation
Defibrosing
Defibrosing the fat is an essential step of microlipostructure. It consists in removing the fibrous membranes that surround the adipocytes. This fibrosis is, in a sense, the enemy of lipostructure: it clogs the cannulas and prevents passage through microcannulas, hence the term microlipostructure. Above all, it is often responsible for indurated cysts after surgery.
Microfat
Defibrosed fat, then passed through a microcannula to obtain the fine particles used to restore volume. It integrates into the deep planes of the face.
Nanofat
Fragmented, filtered fat, without volume but rich in regenerative elements. It does not fill: it improves skin quality, texture, and pigmentation.
Lipostructure
Restoration using autologous fat. Your own adipose tissue is harvested, prepared, and reinjected to give back lost volume. A living, biocompatible, lasting material.
Stromal vascular fraction (SVF)
A concentrate of regenerative cells drawn from adipose tissue. It supports fat integration and tissue quality.
The face
Deep plane
A lift acting beneath the muscle, on the true support layers of the face. It repositions deep tissue without skin tension. Distinct from skin-traction lifts, which are more superficial and less durable.
Frontal endoscopy
Access to the forehead and brow through mini-incisions under video guidance. It repositions the brow and outer canthus with minimal scarring.
Injectable products
Reversibility
What is injected must be removable. This is the rule that governs the choice of products: hyaluronic acid is used because hyaluronidase can dissolve it. Non-reversible products are set aside, not for their efficacy but because they leave no way back.
Hyaluronic acid
The only synthetic injectable I use, because it is reversible with hyaluronidase. It restores volume temporarily. What is injected must be removable.
Hyaluronidase
The enzyme that dissolves hyaluronic acid. It is what makes this product reversible, and therefore acceptable. In case of excess or accident, it allows a step back.
Poly-L-lactic acid
A synthetic product that stimulates collagen formation. I do not use it: it is not reversible and may expose the patient to a foreign body inflammatory response and fibrous encapsulation.
Calcium hydroxyapatite
A synthetic volumizing product, not reversible. I do not use it, for the same reasons: possible foreign body inflammatory response and fibrous encapsulation.
Technologies
CO₂ laser
The laser I use to treat skin quality: fine lines, laxity, texture. Combined with transconjunctival blepharoplasty, it resurfaces the eyelid skin with no cutaneous scar. It acts on the envelope, where fat restores the volume, and the two gestures complement each other.
Microneedling radiofrequency
Effective for certain skin indications. It is not a surgical substitute, and overuse may lead to fat loss and fibrosis.
This glossary grows with practice. It is educational and does not replace a personalised medical opinion: every indication is judged on examination.