Do you really need a blepharoplasty if you can just do fat grafting?

What would advantage be of getting a blepharoplasty if you were having fat grafting below the eyes? Isn't the new fat just going to cover up any bulging fat if the herniation isn't too significant?

Doctor Answers 8

A complex question

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The choice of procedure depends on a lot of factors, the amount of fat protrusion of the lower lids, the depth of the tear troughs, the amount of volume loss in the cheeks, your age, the thinness of the skin, and possible underlying causes for the changes in your eyelids just to mention a few.  That said, the chances of lumpiness from fat injections may be higher, depending on the skill and experience of your surgeon.  This is one of the trickiest areas to inject. Do you homework and get a number of opnions.

Boston Facial Plastic Surgeon


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Perhaps you should get a second opinion. Usually a blepharoplasty will get rid of bags and upper eyelid hooding. I am not sure what areas you are having grafted.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Bags under the eyes can be improved by blepharoplasty as well as fat or fillers injection, but fillers and fat isnt for everyone

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Bags under the eyes come from a few causes. The fat that cushions the eyeball starts to protrude causing bags. Also the cheek muscles and soft tissue droops, making the bone around the eye visible. The combination creates an aging eyelid. If you have very protrusive bags, then fat or fillers won't help.

For patients with mild bags and a deep hollow underneath, called a tear trough, fat or fillers can help. For very large bags or someone who is looking for a consistant, permanent, result, surgery is better.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Fat Grafting versus Blepharoplasty

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Without seeing you in consultation or seeing pictures, it is impossible to give you specific advice. However, in most cases, a combination of blepharoplasty and fat grafting give an excellent result. Blepharoplasty is a general term but can be used to remove extra skin, remove herniated fat, tighten loose support around the eye, etc. Fat grafting is used to add volume and contour or shape the surrounding tissues - not necessary just cover up or smooth out the area immediately around the eye. It is often best to "fix" the underlying problem with the blepharoplasty and replace and augment the missing volume with fat grafting.

Good Luck.

Fat grafting of the eyelids or blepharoplasty

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Thank you for your question. Facial fat grafting is typically done to plump the cheeks and create an ample cheek appearance. V position of the facial fat graft is below the depression underneath your eyelid and will not gland in with or correct the puffy lower eyelid appearance.

Fat grafting can be done in the nasojugal fold to camouflage the puffy lower eyelid but this is a specific procedure and will not be accomplished with fat grafting into the cheek.

The appearance I believe you are looking for based on your question would require an arcus marginalis release and fat grafting just below the infraorbital rim as discussed in the link below.

Fat Grafting vs. a Blepharoplasty?

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Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties. There is no one best procedure. Each has benefits and drawbacks.

Following the advice of anyone who would presume to tell you what to do without taking a
full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Fat grafting v. blepharoplasty

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I agree with Dr. Steinsapir that the public's impression of fat grafting in the lower lids is based upon tremendous misconceptions and lack of understanding of facial anatomy combined with the aging process. Fat grafting doesn't sound surgical to patients and, as is usually the case, you can't judge the book by its cover. Cosmetic surgery must be performed by knowledgeable, board certified surgeons who have expertise. Don't go chasing whatever you see on television resulting from PR hype---have the right operation for your situation.

Fat grafting is very unpredictable.

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It also causes horrible scarring in the normal glide planes associate with the lower eyelid and mid face. Sensible surgeon try to avoid lower eyelid fat grafting whenever possible.

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