Ask a doctor

Lower Eyelid Bleph w/ Fat Grafting vs. Just Fat Grafting Around Eyes?

I am 39 year old female. I have been to 3 different plastic surgeons for lower eye puffiness. One recommends just fat grafting around eyes and maybe removing a little bit of fat from the bulge. Another surgeon, who is a facial plastic surgeon, recommends a lower eyelid bleph w fat grafting. And the third surgeon, who is an oculoplastic surgeon recommends canthopexy??? Why so many different opinions?

Doctor Answers 8

Blepharoplasty With Fat Grafting vs Fat Grafting Alone For Puffy Eyes

Thank you for your question. I would say that the skill and experience of the surgeon that you choose is the most important factor in your decision. The best surgeon rather than a particular technique will most often achieve the best result.

Many surgeons today add fat into the depression or dark circle underneath the "eye bag" to camouflage the puffiness and smooth the eyelid. The benefit of this is that by avoiding fat removal and skin removal you avoid the hollow eye deformity and possible change of eyelid shape.

For mild to moderate puffiness of the lower eyelid fat alone can achieve an excellent result.

I avoid fat injections-I don't like traumatizing the delicate eyelid structures with needle injections and injected fat does not survive as well as a composite fat graft-a whole piece of fat.

Key points for me:

  1. Transconjunctival incision-inside the eyelid-avoid a scar and change in eyelid shape
  2. Release the Arcus Marginals-allows graft to be placed into the Nasojugal Fold-the depression beneath the lower eyelid
  3. Harvest a Composite Fat Graft from pubic area-best fat for grafting, well hidden scar under pubic hair
  4. I do not use Fat Repositioning of eyelid fat-leaving vessels attached to eyelid fat can cause fat to retract back into puffy area and can make eyelid look hollow in some cases
  5. Adding new fat to the upper cheek lower eyelid area can help rejuvenate the midface
  6. Be certain eyelid support is adequate-if eyelid is lax a canthoplasty or pexy is necessary
  7. For severe puffiness or eye bags some fat can be removed with this approach
  8. If excess eyelid skin is present a skin pinch Blepharoplasty can be done to tighten the eyelid without violating eyelid support

Choose your surgeon carefully-ask to speak to patients who have had the procedure.

Fat grafting eyelids

Fat injections may be used to smoothen contours of the eyelid cheek junction. Blepharoplasties help reduce excess skin, bulging fat, and excess muscle. Preparation of your surgery plan involves an aesthetic judgement which can vary from surgeon to surgeon.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 33 reviews

One problem, several solutions.

You have come face to face with the art of cosmetic surgery. There are usually several ways to obtain a result, each with its own pros and cons. My advice to you is to find a surgeon that you feel comfortable with and review before and after pictures of the surgeon's work. Once you feel confident, follow the surgeon's advice, as it will usually provide you with the best result.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
5.0 out of 5 stars 67 reviews

Lower lid puffiness treatment

It sounds like a large portion of your puffiness is due to lower eyelid area volume loss. It can be a judgement call whether any lower eyelid bulging fat needs to be removed. Often at your age, just improving the volume helps, but this really needs to be assessed in person.

A canthopexy procedure would help to tighten the lower eyelid. Done alone, it wouldn't help with your concern regarding lower eyelid puffiness but is sometimes done in conjunction with lower eyelid blepharoplasty approaches where there is a concern that the lower eyelid will be pulled down after surgery.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Improving Lower Eyelid Bags with Surgery or Fat Graft

Hi miamij,

Lower eyelid procedures to reduce bags vary greatly, largely due to a patient's unique anatomy, personal preference, and a plastic surgeon's experience & preference. There normally isn't one answer, but rather many good options to rejuvenate the face. Both fat injections and lower eyelid surgery are good options for appropriate candidates. Another option to consider for younger patients like yourself, to further complicate decisions, is facial filler injections such as Restylane or Juvederm. Only after a comprehensive evaluation can an eye specialist help determine appropriate options for you. Best of luck.

Dr. C

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 64 reviews

Lower Eyelid Rejuvenation - Different Opinions

If you would be able to go to 3 plastic surgeons for a facelift and afterwards look at the result, you would certainly look at 3 different versions of yourself. We base our recommendation not only on your anatomy but also on our own aesthetic preferences.

It sounds like, you would benefit from some filling of your tear trough depressions. In order to help you make your decision, have the surgeons demonstrate to you before and after photos of patients of somewhat similar lower lid/ cheek problems.

Canthopexy tightens the lower lid and is indicated if your lid would be loose.  

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 40 reviews

Lower lid surgery

You ad so many different opinions because of each persons evaluation of the problem and how to correct it. it  is also based on each individual's expertise with one procedure or the other.

In general at today's understanding of aging, is that we loose fat in the face with age.therefore one had to be very conservative removing fat from the face or the eyelids.

in the eye lids the nore fat you remove the more hollowness of the eyes you will get. In few conditions some fat need to be removed but the majority need to be redistributed to fill the tear trough.

In many cases filling the tear trough will even the lower lid and rejuvenate it. But the filling of the lower lid require extreme expertise otherwise you will get lumpy . I start with a filler that I can reverse like Juvederm.

If you like the results i then do micro fat transfer, Fat and fillers has to be injected in small amounts deep to the muscle.

Canthopexy is used for lax lower lid, at 39 I doubt you are very lax. however the canthopexy will support the lower lid to prevent ectropion.

Fat can be distributed in the lower lid through a Transconjunctical approach and the skin is treated with laser for tightening. This will decrease the risks of complications.

The most important aspect of cosmetic surgery is that it is an ART and a SCIENCE. Familiarity with different approaches and understanding what each procedure can and can not do is very important

Continue your consultations till you are comfortable with the surgeon, his expalnation and his/her expertise.

it is also important to find the surgeon who will spend the time to explain all different approaches and analyze your particular situation and the logical approach. Do not base your decision based on financial basis or magical surgery that is used for advertising and loring the patient in

Samir Shureih, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 5 reviews

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.