What should be done for the lower bags and darkness? Relocation, removal and fat transfer? (photos)
Doctor Answers 5
Why fat transfers under the eyes are not advised, and performing lower eyelid surgery performed in context with the whole face
I’ve been in practice for 20 years and I am a specialist in oculofacial plastic surgery, doing a lot of eyelids and facelifts. Facial aging is something that I spend a lot of time on, and I focus on helping people understand the elements of the facial aging process, and how well a particular plan impacts it.
From your photos, you clearly demonstrate lower eyelid fat prolapse, but I point out to my patients who come in for eyelid consultation to also look at the adjacent area called the eyelid-cheek junction, as well as the area of the cheek called the submalar area. When you have bags under your eyes, it is often the dominant feature and it really affects the overall appearance of your face. When people have an eyelid procedure to address the fat pockets, they sometimes think that they look hollow or sad. This is because the adjacent areas of the face have also aged and because they weren’t dominant, the focus was not there.
As a specialist, I can tell you that in my experience, fat transfer to the lower eyelids is not advisable. I see patients from all over the world who have had fat transfer and they end up with irregularities and lumps. They try to build up and restore the fat that’s been lost and then try to camouflage the fat pockets. However, there are several defects in that idea. The fat that is under the eye has prolapsed forward like a hernia, so as herniated fat it has to be addressed in some way to restore it in its proper position. MRI studies have shown that people with fat prolapse actually have more fat, meaning they have an enlargement or an increase of fat. Thus, it’s justifiable to do procedures to reduce or remove the fat.
Moving fat from the orbit or the space may make sense, but a lot of people who get fat transposition will not have a good result. They will actually have chronic swelling in the eyelid-cheek junction. In my practice, I do some fat transposition but with the majority of the patients I do fat reduction because it is logical to reduce fat that is herniated past the rim and to get that type of contour. Concerns about hollowing and things like that are always addressed. Because cosmetic surgery is an art, doctors will have different opinions on how to do the procedures. Every doctor comes to the table with their aesthetic sense, their experience and technical abilities. When it comes to medical care and surgical care, it is really more of a gestalt of how you feel in terms of your comfort level with the doctor and their style that’s demonstrated by looking at before and after results. At the end, it’s always about trust and comfort.
As far as resection versus transposition, I think a lot of very good surgeons do a combination depending on what they see or whatever is appropriate for the patient. Cosmetic surgery is ideally about customization. Some doctors like to do things a certain way and they’ll always do it the same way. Very often, those are the doctors that get themselves in trouble because a certain percentage of patients don’t have an anticipated or ideal outcome.
I think meeting with doctors who have a lot of experience with eyelid surgery, particularly as a specialty, will probably help you make that decision. I think at this point, you are someone who has a little bit of information overload and you just don’t know what to do. You should understand that it’s your decision to find the doctor that resonates with you. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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Improving eye bags and sags
Treatment of lower eyelid bags and darkness
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Fat repositioning is my preferred option for patients with prominent lower eyelid fat bags and tear troughs. Removal, especially in patients without high cheek bones, will contribute to a hollow, aged appearance with time and is something I try to avoid.
Hope this helps,