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Eyelid Fat Repositioning Vs Fat Removal for Eyebags

asked 3 years ago by crystalgurl in NY
Latest answer by Brooke R. Seckel, MD
Question viewed 5,196 times

In blepharoplasty, is lower lid fat repositioning a better choice than fat removal for undereye bags?

18 answers to Eyelid Fat Repositioning Vs Fat Removal for Eyebags

+2

The million dollar question

Fat removal by the transconjunctival approach is a relatively easy procedure, and generally gets good results. However, hollowness can result. Replacement of volume with fat injection, nontraumatized fascial-fat grafts has the possibility of leaving lumpiness, whether temporarily or permanently. A conscientious surgeon will balance the merits of each, explain them carefully to the patient, and help them decide which is the best for their needs, tolerance of problems postoperatively, and... more
Brent Moelleken, MD

Beverly Hills Plastic Surgeon

www.drbrent.com

+3

Eyebags Fat Removal Can Leave Hollow Eyes Fat Repositioning or Grafting Better for Natural Look

Modern Blepharoplasty for Eye Bags emphasizes conservation of tissue including skin and fat. Older Blepharoplasty techniques removed skin and aft and ofetne left the eye looking hollow and lid position pulled down=Sad Eyed Look or Houndog Eye. Today many Plastic Surgeons are using a Transconjunctival Blepharoplasty which is done inside the eyelid and avoids a visible incision and removal of skin. Rather than removing fat the fat is transferred or grafted into the tear... more
Brooke R. Seckel, MD

Boston Plastic Surgeon

www.drseckel.com

+3

Lower eyelid fat pads or "bags"

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin... more
Michael Law, MD

Raleigh-Durham Plastic Surgeon

michaellawmd.com

+2

It depends on your anatomy

The proper treatment of the lower lid is a very complex and much debated subject. Suffice to say that the old fashioned treatment of excessive fat removal is no longer done because of long term hollowing of the lid. Fat repositioning, fat removal, arcus marginalis release, septal tightening and many more, are all acceptable procedures to rejuvenate the lid. Be sure you go to a Board Certified plastic surgeon who does a significant amount of lower lid surgery to sort out what is best for you. more
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+2

Trend is toward fat repositioning

As stated in the previous answers, there is no single best procedure for everyone, you would need to be evaluated. The fat removal procedure has been around for a long time and gives good results in the short term. However, since fat is lost around the eye with aging, the trend now is to preserve it and use it to advantage by repositioning. This can also help smooth the transition from the eyelid into the cheek which is a more natural and youthful look.
Richard Baxter, MD

Seattle Plastic Surgeon
+1

Lower lid blepharoplasty improvement

The improvement of the lower eyelid complex is complex and includes the following approaches: Correction with filler (fat, HA) (See below weblink for just filler) Reposition of fat Removal of fat lower eyelid All of the above are extremely technique sensitive and both the choice and application of the technique are surgeon dependent.
Anil R. Shah, MD

Chicago Facial Plastic Surgeon
+1

Depends on patient's anatomy

This is a very controversial topic in the field of blepharoplasty surgery. Repositioning is an excellent technique for excess fat bags within a person’s orbital anatomy that has a very shallow and gaunt lower eyelid. The lower eyelid repositioning can help with the tear troughs. If there is normal anatomy, simple blepharoplasty with fat removal would be the preferred choice.
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+1

Fat repositioning AND removal for eye bags

Invariably, when a patient comes in for an eyelid surgery consultation, they are focused on just the bags under the eye when they should also be aware of the crease or "tear trough" under the fat over the bony rim. This area should be addressed for an ideal result. Fat repositioning is a nice advancement, but the results can be a little variable and can result in longer swelling. Fat transfer is our method of choice because it is easy, gives a great result, and the healing... more
Andrew Miller, MD

Edison Facial Plastic Surgeon

www.associatesinplasticsurgery.com

+1

Fat removal and fat or filler transfer is our preferred technique

Our procedure for lower blepharoplasty has explored most of the available options for rejuvenation. We did fat excision followed by fat transposition and now fat excision with orbital rim augmentation with microfat transfer or filler. This technique addresses the mulifactorial nature of lower lid aging. The lower lid skin is treated with different technique depending on the amount of lax skin present.
Richard Gentile, MD

Cleveland Facial Plastic Surgeon

www.facialplastics.org

+1

Tear troughs are a difficult problem

One of the more common complaints patients have that leads them to consider lower eyelid blepharoplasty surgery is puffiness in the lower eyelids. Often this puffiness is accompanied by a depression between the lower eyelid and upper cheek. This depression is commonly referred to a tear trough deformity. As you can imagine, the best way to address this depression is usually by a combination of techniques. Judicious removal of fat from the lower eyelids will lessen the puffiness, while... more
Mitchel Krieger, MD

Fairfax Plastic Surgeon
+1

It's important to individualize

Many years ago all we did was remove the fat. However, when one followed these patients as they got older, we noticed that many eyes became 'hollow', suggesting there was too much fat removed. Now, we recognize that over removal of eyelid fat is undesirable. Most of the time the inside fat pad closest to the nose is repositioned into the tear trough. Often, but not always, the fat pad furthest away from the nose is to prominent and some fat is repositioned and some is removed. Everyone is... more
Timothy R. Jones, MD

Saint Louis Plastic Surgeon
+1

GREAT QUESTION!

I love this topic! I'm a firm believer in fat redraping or repositioning. The less fat we remove the better. It can really help the appearance of tear trough deformities . Unfortunately, there has to be the right amount of fat and the right quality of fat. Many times the fat doesn't redrape smoothly and you can end up with a lumpy bumpy appearance. So it's a "game time decision." If i get in there and the fat is perfect for redraping then I'll do it. But if it isn't... more
Christopher L. Hess, MD

Fairfax Plastic Surgeon
+1

There is not one correct answer

There is not an "ideal" surgery what fits every patient. There are several surgeries that are customized for the patient's specific anatomy. If you have excess fat but a fairly smooth lid-cheek junction, then removal of the fat may work well for you. If you have excess fat but a distinct lid-cheek junction, then it may be better to reposition the fat to help smooth out the transition. If you provide pictures, then we may be able to give you more specific advice. Good luck. more
David Shafer, MD

New York Plastic Surgeon
+1

Most patients benefit from Fat Repositioning

After careful examination of a patient's lower lid and cheek anatomy, approximately 80 to 90% of patients benefit from filling of the tear trough area in addition to reducing the puffy under eye area. Because our patients don't just want to have puffiness removed but rather want to look better (and yes, there is a difference between these 2 goals), we perform some fat repositioning in most of our lower blepharoplasty patients. Alternatively, some blepharoplasty surgeons prefer the... more
Frank P. Fechner, MD

Worcester Facial Plastic Surgeon
+1

Each eyebag case is anatomically different

The old classic blepharoplasty involved fat removal only, there is more interest in repositioning the fat now to create a youthful appearance. However, I think that each case is different. Plastic surgeons with experience in lower lid surgery know that in some cases a conservative removal is needed to avoid having reccurence of the lower lid bags.
Hisham Seify, MD, PhD

Los Angeles Plastic Surgeon
+1

Fat repositioning is usually best.

Hi! Fat removal gets rid of the bags, but can leave you looking hollow. After all, we naturally lose fat in the upper face as we age. I usually use fat repositioning with arcus marginalis release or fat injections. The trouble is that fat repositioning is a trickier operation, so you need to go to someone who does a lot of them.
George J. Beraka, MD

Manhattan Plastic Surgeon
+1

This very much depends on the eyelid

Dear Crystalgurl, The transconjunctival lower blepharoplasty with removal of lower eyelid fat can be a fantastic option for the right person. The key with any surgery is case selection. So a young person with just a bit of a lower eyelid bulge will have a great results with a small resection of lower fat using this approach. However, take too much fat or in individuals with a whole lot of lower eyelid issues like skin and eyelid laxity, cheek descent, etc and now you have a situation that... more
Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon
+1

No such thing as best.

It all depends on the anatomy present and the results you are trying to achieve. You can then assess the risks of both, both in terms of achieving your goal and producing unwanted side effects or complications, and then decide which procedure is more acceptable. For some it will be fat removal and for others it will be fat repositioning and in a few it might be both or neither.. Every surgery should be customized to the anatmy and the individual patient. Any doctor who says one is... more
Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon

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