Fat grafting or Blepharoplasty? (Photo)

The area of concern is anatomically complex, and sometimes difficult to understand.
There are often two variables happening at the same time immediately adjacent to each other.
If we start by describing the aesthetically, ideal or what we see in an attractive youthful face, we can then begin to understand the difference in face that shows signs of premature aging.
In the youthful phase, the contour of the lower eyelid is snug and tight.
The area below this in the upper part of the midface is plump and full of volume.
Look at young attractive people, and you can see this.
With facial aging which some individuals are predisposed to based on genetics, the two volumes will reverse.
The lower eyelid will show fullness due to weakness in the Periorbital septum allowing for bulging from the three fat pads deep to the lower eyelid. just below this people develop a lack of volume in the upper part of the midface.
We can differentiate these two variables as one being primary, the other secondary, or both being of equal importance.
Fullness in the lower eyelid is often treated by removing part of the fat pads under the lower eyelid.
Lost volume in the upper part of the midface is usually treated with volume restoration. There are many ways to do this but fillers is probably the best.
Other treatment options for restoring midface include the use of implants, a midface lift, and fat transfer.
Fat transfer can be unpredictable, and I generally recommend patients use fillers because they are precise, predictable, and unforgiving if you don’t like the outcome.
The first question to ask is, is it the fullness in the lower eyelids or loss of volume just below that is the primary problem.
The best treatment option is generally to treat the primary problem first With potential consideration of the secondary issue.
Differentiating between the two variables is not easier straightforward, and there is substantial subjectivity when it comes to treating this area.
This type of work is not easy and outcomes can easily lead to disappointment if patients don’t have a clear understanding of the problem to start with and don’t Select providers appropriately.
To get a quality assessment start by taking quality pictures.
You may need to have someone else take the pictures for you or use the timer on your camera.
Get an area that has appropriate lighting and take pictures showing your face with a frontal view, profile views, and three-quarter views.
Look at how plastic surgeons take before and after pictures to get an idea.
And your case I think loss of volume in the tear trough or upper part of your midface is primary, but there is some fullness of your lower eyelids as well.
Quality work, using fillers could potentially restore. The aesthetic appears of your face, but this type of work is not easy and finding providers who have the skill and experience to deliver consistent quality outcomes is not easy.
I suggest you check out the website of Dr. David Mabie MD in San Francisco. he is a facial plastic surgeon who works exclusively with facial volume enhancement using fillers.
He does not do any other procedures.
I’m not suggesting everybody fly to San Francisco to have facial fillers done but seeing his results can give you an idea of what’s possible with this treatment.
Once you understand the gold standard and what’s possible, you have a reference for comparing other providers results.
During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who have similar facial characteristics to your own.
This is regardless of what treatment they are proposing.
And experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Bring pictures of your own face to use as reference during the consultation.
I suggest you print out quality pictures of your face so you don’t have to rely on using your cell phone.
Use these pictures as reference during the consultation.
Do not rely on your own memory or looking in mirrors during the consult.
I highly recommend patients avoid virtual consultations whenever possible.
This type of work is best done with in person consultations when you can get an accurate assessment and begin the vetting process of finding the best provider.
To find the best provider patients need to take an active role in the consultation process.
It is your job to vet providers regarding skill and experience.
If you take a passive role Without insisting or asking providers to show you sufficient evidence that they have mastered this type of work then you’re taking a chance of ending up with the provider who doesn’t know what they are doing.
Never assume that somebody has mastered any single procedure because they’re board-certified in plastic surgery, have years of experience or overall good reviews.
There’s simply no substitute for providers, showing you an impressive collection of before, and after pictures of previous patients who have the same problem you do.
There’s no correct number of consultations needed to find the right provider.
The more complex and difficult the situation is the more consultations. You’re likely to need to find the right provider.
Searching on the Internet is only gonna get you so far.
Some of the best plastic surgeons are not interested in social media, updating their websites or promoting their practice.
They’re busy taking care of patients and focus on doing that.
Being good at self promotion does generally not mean being a great surgeon.
If anything fame is probably inversely correlated with surgical skill.
The more consultations, you have the more likely you are to find the right provider for your needs.
Understand that this area is inherently, complicated and difficult to treat.
Getting consistent quality outcomes is not something most providers can do in my opinion.
There is definitely potential for quality outcomes, but there is also risk of having unfortunate outcomes that lead to disappointment.
My best advice is to have more consultations than you may think necessary and be more selective as well.
Insist, unseen, sufficient numbers of before and after pictures and if providers can’t supply you with these then ask yourself why.
Best,
Matt Hagstrom, MD