Cosmetic Concern: 59-year-old man bothered by the fullness in the lower eyelids.

Diagnosis:

1. Herniated lower eyelid fat.
2. Lower eyelid wrinkles.
3. Sun damaged skin.

Treatment:

1. Transconjunctival lower eyelid surgery.
2. Lower eyelid chemical peel.

Discussion:  Lower eyelid surgery reduced the fullness of the lower eyelid by removing eyelid fat.  This tends to deflate the lower eyelid and slightly increase the lower eyelid wrinkles.  The chemical peel performed at the time of the lower eyelid surgery, helps to firm the lower eyelid skin and reduce this tendency and avoids the need for surgery to remove the excess lower eyelid skin.