Eyelid Fat Repositioning Vs Fat Removal for Eyebags

In blepharoplasty, is lower lid fat repositioning a better choice than fat removal for undereye bags?

Doctor Answers 21

Lower eyelid fat pads or "bags"

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A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.
As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.
Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.
Structural Fat Grafting of the Lower Lid
As mentioned above, it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.
In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.
In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Eyebags Fat Removal Can Leave Hollow Eyes Fat Repositioning or Grafting Better for Natural Look

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Modern Blepharoplasty for Eye Bags emphasizes conservation of tissue including skin and fat.

Older Blepharoplasty techniques removed skin and  aft and ofetne left the eye looking hollow and lid position pulled down=Sad Eyed Look or Houndog Eye.

Today many Plastic Surgeons are using a Transconjunctival Blepharoplasty which is done inside the eyelid and avoids a visible incision and removal of skin.

Rather than removing fat the fat is transferred or grafted into the tear trough area which plumps the dark circle under the eye and freshens the upper mid face.

Fat removal vs fat repositioning

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The decision of fat removal or fat repositioning is based on what the eyelids look like. If there is a large volume of fat, it may be completely excised or partially excised with some repositioning towards the cheek. In cases where there is mild to moderate extra fat with a hollowing beneath it, moving the fat to the hollowed area is appropriate. Make sure your surgeon is comfortable with both techniques. 

Depends on patient's anatomy

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This is a very controversial topic in the field of blepharoplasty surgery. Repositioning is an excellent technique for excess fat bags within a person’s orbital anatomy that has a very shallow and gaunt lower eyelid. The lower eyelid repositioning can help with the tear troughs. If there is normal anatomy, simple blepharoplasty with fat removal would be the preferred choice.

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

There is not one correct answer

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There is not an "ideal" surgery what fits every patient. There are several surgeries that are customized for the patient's specific anatomy. If you have excess fat but a fairly smooth lid-cheek junction, then removal of the fat may work well for you. If you have excess fat but a distinct lid-cheek junction, then it may be better to reposition the fat to help smooth out the transition. If you provide pictures, then we may be able to give you more specific advice. Good luck.

It depends on your anatomy

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The proper treatment of the lower lid is a very complex and much debated subject. Suffice to say that the old fashioned treatment of excessive fat removal is no longer done because of long term hollowing of the lid. Fat repositioning, fat removal, arcus marginalis release, septal tightening and many more, are all acceptable procedures to rejuvenate the lid. Be sure you go to a Board Certified plastic surgeon who does a significant amount of lower lid surgery to sort out what is best for you.

Trend is toward fat repositioning

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As stated in the previous answers, there is no single best procedure for everyone, you would need to be evaluated. The fat removal procedure has been around for a long time and gives good results in the short term. However, since fat is lost around the eye with aging, the trend now is to preserve it and use it to advantage by repositioning. This can also help smooth the transition from the eyelid into the cheek which is a more natural and youthful look.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Lower Eyelid Surgical Options

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It's not unusual for patients to develop prominent periorbital fat pads with normal facial aging. When this situation arises, a variety of treatment options are available. Both blepharoplasty with fat resection and blepharoplasty with fat pad re-positioning are commonly utilized alternatives. The specific procedure chosen will depend upon the patient's aesthetic goals and anatomic findings. It's important that treatment be individualized to accomplish the patient's goals.

Each of these procedures offers advantages and disadvantages. Historically, fat pad resection has been used extensively, but recently plastic surgeons have stressed the importance of fat preservation. This is especially true when tear troughs are present.

If you're considering blepharoplasty surgery, it's important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to determine which surgical option is best for you.

Lower eyelid fat repositioning and limited fat removal can both be valuable

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There has been a very strong trend in eyelid surgery (and in facial surgery in general) toward fat preservation and away from fat removal.

That said,  every case must be individualized.  Sometimes fat removal is still a valuable option.

In many cases, I will sparingly remove fat from certain areas and reposition most of the fat over the bony rim.

Experts in eyelid surgery will customize their surgery to a patient's individual anatomy rather than always sticking with one set technique.


Mark J. Lucarelli, MD, FACS

Madison, WI

Mark J. Lucarelli, MD
Madison Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Lower lid blepharoplasty improvement

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The improvement of the lower eyelid complex is complex and includes the following approaches:

  • Correction with filler (fat, HA) (See below weblink for just filler)
  • Reposition of fat
  • Removal of fat lower eyelid

All of the above are extremely technique sensitive and both the choice and application of the technique are surgeon dependent.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 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.