Lower blepharoplasty for fat removal
In our practice, we do not recommend fat grafting placed in the lower lids due to complications we have seen from that procedure performed elsewhere. The primary goal of lower eyelid surgery is to remove the fatty deposits creating the puffiness look in the lower lids. The incision is located on the inside of the eyelid known as a trans-conjunctival approach. For many examples, please see the link and the video below
Fat grafting to lower eyelids
Fat grafting to the lower kids is only indicated if there has been a prior procedure where the lower lid fat was removed. Otherwise the fat of the lower lid region can be blended with midface fat to recontour the area. This can be done through a lateral minimal access incision I published in Plastic and Reconstructive Surgery in October of 2013 as long as your issue is not far advanced. If however you have fat loss from prior surgery it may very well be necessary to do fat grafting. Micro fat grafting with a tiny needle can yield good results but the risk of complications is higher than with recontouring.
I agree with Dr Freeman. Adding fat is not my first choice unless there is a deficit. Elevating the midface and reshaping the lower eyelid will give a more predictable result long term.
majorminor, This is not the approach I would use; the fat behind the eye belongs in this position and if one learns how to lift the midface fat that has fallen (the SOOF) they will get a much better predictable result. I would recommend you find a specialist in the face that is familiar with this approach. See the video and search the Internet. Good luck!
Lower blepharoplasty addresses the aging changes of the skin muscle and fat around the eyes. The surgery can be done as an in office procedure in less than 90 minutes. The circles under the eyes can be gone by moving the fat from the bulge into the adjacent valley, tightening the skin and supporting the muscle. Easy. See a board certified plastic surgeon for an opinion. Good luck.
Lower bleph with fat grafting
This is a surgery that can work well when done correctly. Photos would help here. If you have significant fat pads, repositioning of the fat into the tear trough is the best way to smooth out the area. If you don't have enough fat, and have some hollowing, fat transfers can fill in the hollow. There are some possible issues with this surgery. Some patients may look great, and others may form some hard nodules. If you get the fat nodules, they are hard to get rid of and often have to be surgically removed. So if you have big fat bags in the lower lids already, moving that fat is the better option.
Under eye bags
This is a great procedure and many times we put fat along the tear trough which is a fold along the inferior edge of your lower lids to smooth this out.It is a tricky area to graft.Usually I will take the fat from your lower lids and reposition it into that fold to smooth it out.This works well.