After lower blepharoplasty with fat transposition, can the transposed fat sitting over the bone be removed?

Question

I had no herniated fat. The dr said he was just smoothing contours. Not that he was moving two of my fat pads down to my cheek and completely removing the lateral one. I am left with holes in my orbit and you can see the Outline of my lateral bone. And you can see the edge of the fat that was draped over the bone in the medial and central area. Am I able to go in and just have the fat that was draped over the bone removed? Will The base of those fat pads then sit in their original neutral place?

Zoran Potparic, MD · Answer

One option is to redo surgery using same approaching incision on the eyelid and release, trim, reshape visible contoures. The other option would be to place small amount of nano and microfat grafts over these areas and create fine padding which will smoothen current result? This is best to be discussed with your surgeon or you may consider second opinion consult with a surgeon with extensive experience in periorbital fat grafting. Hope this helps.

Randal Haworth, MD, FACS · Answer

It sounds like you may have undergone a lower eyelid blepharoplasty or eyelid contouring procedure where your surgeon removed some fat pads and smoothed contours. It's important to note that fat removal or repositioning during blepharoplasty can sometimes result in an overcorrection or undercorrection, leading to contour irregularities, visible bone, or hollowness in the orbital region.

If you are left with a visible contour irregularity or hollowing around the orbital rim, you should consult with your surgeon and discuss your concerns. Depending on the extent of the problem, there may be different options available to address the issue.

If you are only seeing a contour irregularity in the area where the fat was repositioned, then removing or repositioning the fat again may help to improve the appearance. However, the fat pads may not be able to be repositioned back to their original neutral place.

It's essential to have a thorough discussion with your surgeon about your concerns and goals for the procedure. They can evaluate your specific case and provide you with the best recommendations for addressing your concerns. Additionally, they may suggest different procedures, such as fat grafting, to help fill in any hollow areas and restore a more natural contour to the orbital region.

I hope this helps,
best of luck !

Randal Haworth MD - Los Angeles

Mats Hagstrom, MD (license on probation) · Answer

It’s definitely possible to remove the fat pads that were transposed with the intention of creating desirable volume most likely in your tear trough. This operation can be done using two different approaches. One is by making an incision along the lower eyelid called an open blepharoplasty or making an incision on the inside of the eyelid called the transconjunctival incision. 
If the corrective procedure is done within a week or few days after the original procedure than this iPad can easily be moved to its original place, or simply be removed.
Revision surgery should generally either be done as soon as possible before scar tissue has been created or it’s better to wait until all the scar tissue has matured and do the revision at that time. You did not include time references of when the surgery was done so most likely, it’s better to wait the appropriate amount of time and then have a revision. Whether you have your original provider do it or someone else they may or may not want to use the same incision site for revision work. Removing the part of the fat pad that’s been pulled out causing a problem should not be that difficult. Whether the rest of the fat pad goes back to its original position is uncertain, but may not aesthetically be important.
I generally encourage patient to be very selective when choosing providers for cosmetic surgical procedures. In the end, quality results are generally based on two variables. Those are the patient’s candidacy for the procedure, and the second variable is the skill of experience of the provider.
For many procedures, there’s not much patients can do to change their own candidacy. Candidacy is important, because somebody people are exceptionally good candidates for certain procedures, while others may not be. Somebody is not a good candidate can not have a great outcome no matter who does the procedure. Understanding your own candidacy for the procedure is very important in setting correct expectations. To get the best results based on that requires finding the best provider. In my opinion, this always requires vetting and number of plastic surgeons preferably locally in your community.
The key to finding surgeons who can do the job correctly is to review their history by getting access to their complete set of before and after pictures.
Providers tend to be apprehensive about showing any or all of their before, and after pictures, other than preselected images, representing the best results of their career.
This is something patients have to except to some degree, but you should still be an advocate for yourself and request to see as many before and after pictures as possible. I typically use the reference of an experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients.
During consultations ask providers to show as many before, and after pictures of previous patients, who are very similar body or facial characteristics to your own. It’s a good idea to bring in pictures of yourself to use for reference to make sure they’re showing you pictures of previous patient who had the same concerns. 
I recommend each patient push providers a little bit and ask them to show you a variety of outcomes, including excellent results, average results and results that did not turn out, as well as they had hoped. We all have a variety of outcomes, and in my opinion it’s fair game to ask to see them. In my opinion the most talented and experienced surgeons will be confident enough to show you pictures of whatever outcome you’d like to see. 
Become familiar with what quality results should look like for the procedure you’re interested in. Create a rating scale for quality outcomes. Recognize them when you see them. During age in person consultation take careful notes, especially regarding both the quantity and quality before and after pictures shown. 
Bing show me a handful of preselected images representing the best results. Other providers career is completely insufficient to get a clear understanding of what average results look like in the hands of each provider nor does it tell you how many of these procedures they’ve actually performed. 
There’s no correct number of consultations to have before choosing a provider, but the more consultations the patient schedules the more likely they are to find the best provider. This can be a time consuming process, but considering that poorly done procedure can leave people with defects and undesirable outcomes, including disfigurement, that is permanent.
For this and many other reasons, I encourage people to be far more selective than they think necessary when it comes to choosing plastic surgeons. There is inherent variation in the skill of providers. The variance in outcomes among different providers depends a bit on the procedure. Some procedures are very straightforward and most plastic surgeons get consistent results. Other procedures Are very difficult and only a few select individual providers who’s mastered that procedure can get consistent quality results on a regular basis. Being board-certified and plastic surgery with years of experience, and having a good reputation, does not mean that they’ve mastered any one single procedure.
You didn’t include pictures so we can’t make an assessment. If you’re seeking a second opinion consultation, then you should come prepared bringing with you proper before and after pictures and a copy of your operative report from your previous provider. These are all available to you if you request them as they are part of your medical record.
It may be very reasonable to ask your current provider to do the revision work, and he may certainly be able to do that. Generally speaking, the best providers are doing revision work are the ones who can do the primary procedure the best as well.
Without seeing pictures, it’s hard to make any kind of assessment, but based on what you describe, this does not seem like something that should be that difficult to correct or at least get some improvement.
Would you describe is a fairly typical approach, and it’s done routinely by plastic surgeons around. The lower eyelid area is complex and to get a youthful appearance sometimes requires removing tissue and adding volume in very close proximity‘s which can be tricky.
Best,
Mats Hagstrom, MD

After lower blepharoplasty with fat transposition, can the transposed fat sitting over the bone be removed?

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