When is it necessary to keep the fat in an eylid surgery?

Some surgeons keep the fat and spread it somewhere around the eyes during an eyelid surgery, when is it necessary to keep the fat for the eyes?

Doctor Answers 10

When is it necessary to keep the fat in an eylid surgery

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Over-aggressive fat removal during eye surgery can make the eyes look hollow and older.Maintaining fat, when possible while still getting the desired improvement is always a good idea.

Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Fat is golden.

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In the past we really did not respect natural fat enough.  This lead to overdone surgery that was very unsatisfatory.  Now we are much more careful or should be with the removal of fat.  It is far better to conserve and repurpose living fat in the eyelid.  This is done both for upper eyelids and lower eyelid.  It is critical to preserve fat in both the upper and lower eyelid surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eye surgery

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Libbra, fat should not be removed in general from the lower lids and selectively from the upper eye lids. Choose a facial specialist when it comes to your surgery; when a surgeon does "only faces" for decades they tent to get better results. When it comes to your lower lids choose a surgeon that is familiar with the "SOOF lift blepharoplasty". See the video and good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Fat preservation in blepharoplasty

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dear Libbra, experience has shown that appropriate preservation and transposition of fat achieves the best long term results in blepharoplasty surgery. This is true for both upper and lower eyelids. Of course excess bulging fat pads must be adequately but conservatively addressed to achieve the desired aesthetic result. As suggested be sure to see a board certified specialist for consultation.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Keep the fat in blepharoplasty

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If there is hollowing of the periorbital area in addition to fat prolapse, your doctor may recommend fat transposition blepharoplasty. The trend is to maintain volume and to avoid a hollowed out skeletonized appearance. It is best to consult in person to see if you are a candidate for this procedure with an Oculoplastic surgeon, Facial Plastics or Plastic Surgeon who has lots of experience with eyelids.

Debra M. Kroll, MD
New York Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

When is it necessary to keep the fat in eyelid surgery?

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When patients have a pre-existing gaunt appearance  in the upper eyelids, we will perform a transposition of the fat from the media location to the middle part of the eyelid. In lower eyelid surgery, we perform a conservative removal through a trans conjunctival approach on the inside of the eyelid. For many examples and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

When is it necessary to keep the fat in an eylid surgery?

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Hello Libbra - Thanks for your question. Some might argue that fat transposition surgery is always the way to go because it reduces the chance of patients looking hollow. Fat removal surgery, over time, leaves some patients looking gaunt and hollow. In general, the best time to keep the fat is in a young patient with midface bone loss that makes them look like they have fat bags when they really just have less bone support. In this instance, the fat is repositioned over the hollow lower edge of the bony orbit to fill the tear trough back up with volume. I would recommend that you consult with a specialist in eyelid surgery for more information. 

Good luck, 

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 69 reviews

Keeping the fat in lower eyelid surgery

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I believe you are referring to lower eyelid (blepharoplasty) surgery with fat transposition.  The lower eyelid is one area that has a complex anatomy and consequently there are many different surgical approaches to this area.  I would consider doing this procedure in who have a deep groove beneath their lower eyelid bag or what some people call the double convexity profile.  This is where from the profile view it seems like there is a bulge just below the eye from the orbital fat and a second one from descended mid facial tissue.  In-between there seems to be an indentation where there is think skin over the orbital rim (bony eye socket).  The fat can be moved over the orbital rim to pad this area and create a smooth contour.  This approach is also useful in patients "negative vector profile" where the eye farther forward than the cheek below.  Lower eyelid fat removal can create a hollowed unnatural appearance in these patients.  

Catherine Weng, MD
Denver Otolaryngologist
4.0 out of 5 stars 4 reviews

Keeping the fat in eyelid surgery

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Keeping some of the periocular fat is necessary in eyelid surgery - upper lids and lower lids - to avoid a gaunt or unhealthy appearance. Repositioning the fat in lower lid surgery diminishes the risk of developing an over-done, gaunt appearance. This repositioning often improves the "tear trough" area or "dark circles" along the orbital rim. If your cheek tissues are thin and you have dark circles with puffy fat pads above, ask your surgeon specifics about the surgical plan as well as the risks and benefits with each type of procedure. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Changes in care

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Many surgeons have moved from completely removing the fat to repositioning it to more favorable positions. This is particularly true for the lower lid and lower fat pockets. For instance, I get the best results when I use the lowest fat pockets to blunt the lower orbital rim. This blends the transitions from the eye to the face and treats the hallow eye appearence and tear trough deformity. 



Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 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.