I have under eye hollows and slightly puffy lower lids.. Fat transfer / fillers suggested however one surgeon has proposed subconjuntival blepharoplasty in addition to fat transfer. I do have slightly dry eye and large eyes and I know that blepharoplasty can pose risks in these circumstances so might just try with the fat transfer first and see how I go...however I wondered if I went that way, whether previously having had fat transfer might make blepharoplasty more difficult in anyway?
Blepharoplasty After Fat Transfer?
Doctor Answers 11
Blepharoplasty After Fat Transfer?
Thank you for your question. You should see a Board Certified Plastic Surgeon or Oculoplastic surgeon to have an evaluation, and discuss the alternatives including fat transfer or filler. Then you can reach an informed decision. I hope this helps.
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Blepharoplasty After Fat Transfer
the future. There is no harm to having the filler done first, provided
it is in fact indicated.
Blepharoplasty following fat transfer
For hollowness in the tear trough, fat repositioning or a filler such as Restylane will yield a fantastic result. The fat transfer is a more permanent option, and the fat typically has around a 40% take. This will not help with puffy lids. This is something that a lower blepharoplasty would address. If you have a fat transfer to help reduce the appearance of under eye hollowness, it will not affect your surgeon's ability to perform a lower blepharoplasty. Having dry eyes is a contraindication for blepharoplasty surgery. However, an exam by a board certified opthamologist can help determine the cause of your dry eyes. If the condition is improved, a conservative approach to the surgery is not out of the question. I hope this helps, and please feel free to ask any additional questions!
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Blepharoplasty after fat transfer
We do not recommend fat transfer into the lower lids. Since the skin is so thin on the eyelids, any little irregularity of fat can show right through the eyelids and are extremely difficult to remove. Remember that fat cells are physiologic and will enlarge in size depending upon total body weight gain. Patients who gain excessive weight after a fat injection can have significant deformities present since the fat enlarges with the body weight. It is certainly acceptable to undergo a transconjunctival blepharoplasty to remove a conservative amount of herniated fat in the lower lids creating the double bubble effect on the lower lids.
Treatment of lower lid hollows
There are a variety of approaches to lower lid hollows. One first step could be Restylane. Another would be to consider Selphyl, which is autologous platelit-rich fibrin matrix to stimulate collagenesis. Another is fat injection. Finally, there is always surgery. Having any of the less invasive methods first will not preclude surgery at a later date or make it more difficult.
Blepharoplasty and Fat Transfer
Blepharoplasty is often combined with fat transfer but each procedure can be performed independently as well. The fat transfer should not impact future blepharoplasty surgery, particularly transconjunctival blepharoplasty.
Can blepharoplasty be done after fat transfer?
It would help to see pictures. As we age we lose the fullness of the upper cheek and this tends to unmask the fat of the lower eyelid. Often a judicious fat transfer to the cheek and tear trough areas can be helpful, especially if the amount of true fat bulging is relatively limited. It is possible to combine a transconjunctival blepharoplasty with a fat transfer, but it is also perfectly acceptable to start with a fat transfer. One important qualifier: like all surgery, fat transfer is technique and experience dependent.
Posting photos would be helpful
Blepharoplasty [with or without fat repositioning], fat transfer, and dermal fillers each can have a role in rejuvenation of the eyelids depending on the individual patients anatomy. And sometimes more than one procedure may be an option.
Fat transfer is a technique dependent procedure and experience really matters because it can be a more difficult problem to address. Blepharoplasty can be done after grafting, and occasionally needs to be done BECAUSE of fat grafting. The procedures are not mutually exclusive.
Fat transfer prior to blepharolasty is likely OK.
Several materials are used to fill in the eye hollows. Regular fillers (Restylane, Perlane, Juvaderm) have the advantage of being available off the shelf, are relatively predictable in performance and temporary, so if you are unhappy with the results it last 6 - 10 Months. Fat transfer, in spite of the claims to the contrary is not as predictable and there can be contour irregularities after fat grafting which are difficult to correct and are permanent. Should you get a contour irregularity, this may impact on a future surgery to rejuvenate your eyelids.
Blepharoplasty and Fat Grafting
Depending on the exact problems being corrected, both fat grafting and blepharoplasty can be complementary procedures. When there is some fat bulging in the lower lids, transconjunctival blepharoplasty can be a good option, but hollowing around the orbits needs to be addressed with either a fat transposition procedure (a special technique of lower blepharoplasty) or with fat grafting around the rim.
You are correct that with large, prominent eyes, there is a risk of some lid retraction with blepharoplasty if not performed correctly.
If you undergo fat transfer alone, it should not affect you being able to have blepharoplasty in the future and would not normally make the procedure more complicated down the road.
-Dr. Jamil Asaria
FACE Cosmetic Surgery