Is it advised to do lower blepharoplasty without fat repositioning?

Question

Is it advised to do lower blepharoplasty without fat repositioning? Is fat repositioning a part of lower blepharoplasty or are they considered separate procedures?

Mehryar (Ray) Taban, MD, FACS · Answer

Fat repositioning should be done to avoid sunken hollow eyes after lower blepharoplasty. If only eye fat is removed, then hollow sunken eyes can happen. Preserving the eye fat bags and repositioning will avoid that problem.

A.J. Amadi, MD · Answer

Although excising fat during a lower blepharoplasty is sometimes needed, most cases of lower eyelid fat prolapse are best addressed with a fat preserving technique. This involves repositioning the excess fat into the tear trough hollow below. This does increase the time and complexity of the case, but usually delivers the results that can last a lifetime. Experience Oculofacial plastic surgeons almost exclusively use this technique to avoid over hollowed eyelids.

Charles S. Lee, MD, FACS · Answer

It depends very much on your anatomy. If the primary issue is a tear trough groove that's visible, I prefer fat repositioning. If you are young, suffer from allergies and have mainly a fat bulge, usually it will be removal of fat. I sometimes use fat grafting if there is not much fat but you have significant exposure of the tear trough groove.

Jeffrey Joseph, MD, FACS · Answer

First , it’s important to realize that the lower lid lengthens with age, and should be treated according to the issues seen.  I personally do lower lids three different ways; it truly depends on patients desires and what I see on exam.  I used fat repositioning in approximately 40 percent.  I perform a SOOF lift 30 percent and 40 percent careful fat removal without repositioning.  They almost always include either resurfacing or skin pinch.

Sanjay "Jay" Keni, MD · Answer

Hi Momo,Fat repositioning, to clarify, is essentially loosening up the lower eyelid fat (which causes the puffiness of the lower eyelids) and suturing it down onto the cheek bone so that it heals in that position.This technique is not always done with lower blepharoplasty, but the surgeon will sometimes do this during the lower blepharoplasty in order to fill in the area between the lower eyelid and the cheek-- the depression known as the 'tear trough.'Bottom line: it depends on your anatomy.  If you have a prominent tear trough, your surgeon may consider this technique during your lower blepharoplasty, or may recommend fat transfer or fillers.Best wishes,Dr. Jay

Afshin Farzadmehr, MD · Answer

Fat repositioning is not commonly performed if at all.  Key to excellent results is conservatr and adequate addressing of puffiness without incision on the skin nor sutures.  Quick healing and recover back to work in a day.  When you hear much more than this you are bound to have risks of complications and problems.

William Portuese, MD · Answer

In our practice, we do not perform fat repositioning for a variety of reasons. We perform a conservative fat removal through a trans conjunctival approach located on the inside of the eyelid. This addresses removal of the fat bags creating the puffy look. If there is excess skin present on the lower lids, then a pinch technique can accomplish improvement in that area.

Richard W. Westreich, MD · Answer

For many years in lower eyelid bag surgery, fat was removed. Results were good to great. In some patients without deep tear troughs this is the right procedure. Patients with tear trough formation, however, do much better with fat transposition (or repositioning) surgery. The lower eyelid is full but smooth, rather than flat but elongated. So the answer depends on the tear trough.

Sunny Park, MD, MPH · Answer

Lower blepharoplasty can mean different things but usually it comprises of any combination of the following: skin excision, tissue lifting, fat removal and/or fat transposition.  And what you may need in the end depends on your anatomy.  Depending on whether you have fat protruding out, you may or may not need fat removal or fat transposition.  Fat transposition is usually helpful when you have some fat protrusion with tear trough formation.

Tim Sayed, MD, MBA, FACS · Answer

All surgeons have slightly unique techniques to lower blepharoplasty. Fat repositioning is commonly done by some experienced eyelid surgeons in order to blend the tear trough and lid-cheek junction regions, rather than removing too much fat. However, there are a lot of pitfalls and repositioning the fat may require violation of certain boundary tissues which may have negative consequences if the fat does not blend well. I have not found fat repositioning to be a reproducible technique when compared to conservative removal in many patients.

Is it advised to do lower blepharoplasty without fat repositioning?

Answers (20)

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