I have bags under my eyes with troughs and am interested in fat repositioning because I think it gives a more youthful look. However, I read it can be risky. What credentials should I seek in a surgeon performing this procedure? Is board certification in only ophthalmology sufficient or is only ABPS sufficient or more important, since fat manipulation/scar technique is involved? Experience-wise, is it necessary that the surgeon perform this procedure every day, or is less often in conjunction with facelifts adequate? I'm early 40's. Thanks in advance.
Credentials to Look for in a Surgeon Offering Fat Transfer to Under Eye Troughs?
Doctor Answers (7)
Fat transfer and fat grafting are not the same
Eyelid rejuvenation may involve several different approaches depending on the patient's situation. Many times there appears to be excess fat bulging in the lower eyelid with a deficiency of fat in the, so called, tear trough region. Treatment options may include; removal of eyelid fat, repositioning the eyelid fat into the deficient area, fat grafting from a remote body region, or a combination of the above.
The best outcomes are found among physicians with extensive cosmetic eyelid surgical experience. A board certified plastic surgeon, who is also member of the American Society of Aesthetic Plastic Surgery, should be able to advise you as to the best approach in your particular situation. Fat grafting in this area requires a great deal of skill and expertise that many physicians do not possess. It is easy to create further problems in the tear trough area if it is not approached properly. Regardless of credentials, be absolutely sure your doctor has vast experience in the technique he/she is recommending.
Credentials for periorbital surgery
Rejuvenation of the lower eyelid may involve fat repositioning, fat resection, arcus marginalis work, fat grafting, canthal repositioning surgery, nontraumatized fat-fascial grafts, or cheeklifts. The lower eyelid appearance is also heavily affected by the appearance of the cheeks, the SMAS bulk allotment (affected by facelifts), brow appearance and positioning, etc. A board certified plastic surgeon with expertise and interest in the midface familiar and adept at all the techniques above may be your best bet.
Your post mentions you are looking for fat transfer and fat repositioning, two completely different techniques.
Rather than seek out a doctor who does exactly the procedure you think you need, you may be better off consulting with noted plastic surgeons known for their reputation and results, and hearing what their plans for your eyes would be. After a few consultations, certain doctors may stand out to you.
Ultimately, the expertise and reputation of the individual surgeon is more important than the individual technique you think you need.
Periorbital fat transfer credentials
There are several approaches to improving the lower eyelid/tear trough region:
- blepharoplasty with removal of the excess eyelid fat
- blepharoplasty with repositioning of the fat into the area of deficiency below the eye
- transfer of fat from another part of the body with grafting (usually via injection) of the soft tissue deficiency. This can help camouflage the visible puffy areas of the lower lid.
Several types of surgeons can perform this type of surgery (Facial plastic surgeon, Plastic surgeon, oculoplastic surgeon) but not all have experience in all techniques necessarily. It's important to assess your potential surgeon's results to determine if they're a good fit.
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Choosing a surgeon for fat transfer
When receiving surgery under the eyes, remember that a small amount of fat will go a very long way. Also note that even a small amount of overcorrection will be obvious. For this reason, it is essential, to work with a board-certified plastic surgeon who is well experienced in fat transfer techniques and in blepharoplasty and brow lifts as they will be able to recommend which combination is best for you. Commonly, our patients receive a small amount of fat transfer to the tear troughs and then a correction of the excess skin or wrinkles in the lower eyelid.
Experience is key with fat grafting
Surgeons from several different subspecialties perform fat grafting. There is a learning curve with fat grafting techniques so is important to find a surgeon with at least a hundred cases of experience.
How to find good surgeon for fat transfer.
This is such a common question that I wrote an article for RealSelf about how to pick a good surgeon (for a cosmetic procedure such as fat transfer). You can read it on my profile.
Fat Transfer is just an adjunct to blepharoplasty
Fat transfer represents an adjunct to blepharoplasty. Most modern facial surgeons will talk to you about maintaining or adding volume to the lid-cheek junction. This can be done using fat transposition using eyelid fat that used to be removed and discarded or fat transfer. Personally, I prefer the fat transposition approach if a lower blepharoplasty is performed for puffy lids. Rarely, fat transposition and fat transfer are done simultaneously to the same area.
In regards to credentials, many surgeons are rather proud of their own "heritage" and background and they may believe strongly that they can do things best. Look for somebody who can address your concerns in a comprehensive manner. If it is only the lower lid region, most of modern blepharoplasties are performed by oculoplasty surgeons, facial plastic surgeons or whole-body plastic surgeons. The surgeon will most likely be board certified in one of these specialties but board certification will tell you nothing about their experience with advanced eyelid rejuvenation, how often the surgeon performs a particular procedure and quality of his work.
Do your research and consult with more than one surgeon, if in doubt.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.