There is a procedure for reducing fat in the upper eyelid, and it is called ROOF excision.
The patients who tend to need it look something like this.
It is as if a small dumpling is sitting on top of the lid.
ROOF stands for retro-orbicularis oculi fat.
This is the layer marked R in the diagram.
It is the fat layer behind the orbicularis oculi, distinct from the orbital fat we typically remove.
ROOF is not an easy fat layer to remove. It needs a careful hand. Otherwise, you risk hematoma formation or the development of multiple folds.
This shows the appearance after ROOF excision.
Some residual fullness may persist if the skin itself is thick, but proper ROOF excision delivers a meaningful improvement.