Are Oculoplastic Surgeons Better at Fat Transfer?

Question

I am 36, Asian, and have a hollow left upper eyelid as a result of a "failed" Blepharoplasty. I'm looking up fat grafting to correct this, and I'd like to know, are oculoplastic surgeons better at this procedure?

Ricardo L. Rodriguez, MD · Answer

Your case is complicated, as there is already a previous operation clouding the issues.
In general, an oculoplastic surgeon will be very well qualified to deal with all your issues, but so will a well trained PlasticSurgeon. The oculoplastic surgeons are not as attuned to the overall esthetic issues of the face, the Plastic Surgeons are not as attuned to the functional issues of the eyelids.
There are also many Plastic Surgeons who are also trained ophthalmologists. In your particular case I would focus on the surgeons particular expertise, so ask around other medical professionals for a referral.

Larry S. Nichter, MD, MS, FACS · Answer

Both Plastic Surgeons and Oculoplastic Surgeons are trained in these problems. In your case since it is a secondary procedure as a result of a "failed procedure" you need to find the best possible surgeon which is not necessarily from which discipline he/she trained in. Further you need to select a surgeon that is an expert in revision surgery and Asian eyelid surgery. This involves a lot of research and asking the right questions including the number of cases like yours that he has performed, asking to see before and after photos, references and making sure he is a board certified plastic surgeon.

Chase Lay, MD · Answer

At the very least you want to see someone who is a specialist in Asian eyelid surgery AND has experience in reconstructive procedures.  Oculoplastics surgeons are great and specifically trained for eyelid work, however, only a minority of them will be experienced in your specific issue.   The issues your are having occurred a lot in the '70's and 80's when this sort of upper lid surgery was popular in the Asian female demographic, no I am seeing those patients back and have been performing their revisions with fat or facsia grafts.  Let me describe a some of the potential solutions to your problems.  First remember, revision work with free tissue grafting is somewhat unpredictable but will still give you a great improvement, it just may not be perfect.  How it's done:

	1.  You're left upper lid does have some ptosis (droop) and significant hollowness.  The ptosis can be repaired simultaneously with the tissue graft by shortening the muscle & tendon that opens your eyelid.  This is done through the same incision used to placed the graft.  This doesn't add much to the healing time.

	2.  The hollowness would be repaired with either fat from your abdomen or facsia from behind your ear.  The grafts from either place will do you no harm but the fascia from above/behind your ear will give you a better cosmetic result for the graft site since the incision is hiden in your hair as opposed to fat graft from your abdomen or thigh.  My prefered graft is fascia.

	3.  Your right lid I would not touch and simply try to match the left side to the right as best you can. 

	4.  Get several consults.  A lot of surgeons may say they do this but the reality is that unless you  have a doctor who see's a lot of Asian eyelids, chances are they haven't really performed this procedure.

	5.  As a temporary measure adding some fat to the upperlid would help the hollowness if you can't go through surgery any time soon.

	Hope that helps.

	Dr. Chase Lay

Elizabeth F. Rostan, MD · Answer

It appears that your eyes have several issues that need to be addressed. While there are many dermatologists and plastic surgeons that are very good at fat transfer and filler to the upper eyelid, I do think that most of them would still refer you to an oculoplastic surgeon who is very experienced in both cosmetic and reconstructive eyelid surgery.

Jonathan Hoenig, MD · Answer

In addition to hollowness, you have a very high crease on the left as well as eyelid ptosis (droopiness). I do suggest you go to an oculoplastic surgeon who can address all three of your issues. Oculoplastic surgeons are trained specifically in plastic surgery of the eyelid and surrounding structures.

Brooke R. Seckel, MD, FACS (retired) · Answer

You need to find an expert who is experienced in Asian
blepharoplasty

and revisional blepharoplasty. The doctor is most important not the name of his/her specialty. An experienced
plastic Surgeon

or occuloplastic surgeon can help you, but an inexperienced plastic surgeon or occuloplastic surgeon will not.
There are several possible issues that are causing the asymetry and hollow of your eyelid following Asian upper eyelid blepharoplasty:
Excessive fat removal from the left upper eyelid
Too much skin removed form the left upper eyelid
Injury to and retraction of the Levator mechanism of the left upper eyelid
I would NOT do fat injection. placing a needle to inject fat into the left upper eyelid could easily further injure the levator mechanism of the left upper eye.
The Levator mechanism is responsible for controlling eyelid fuction and from your photo it appears this structure is not protected by the normal amount of fat.
An expert needs to surgically explore the upper eyelid. he/she will likely need to repair the Levator aponeurosis to achieve symmetry of your eyelid fold. If additional fat is needed then a composite graft (a whole piece) of fat can be used. I harvest this fat from inside the elly button which hides the scar.
You need to consult several doctors and evaluate theri plan. If all they offer is fat injection through a needle--find another doctor.

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