Eyelid Fat Repositioning Vs Fat Removal for Eyebags

It’s a great question and one that many are confused about.  I always remove the excessive fat and usually some skin as well.  The concept of repositioning the fat makes no sense to me.  If you have that done you will probably be back eventually to simply remove that fat,  which should have been done initially.  Some plastic surgeons are obsessed with making things complicated but I prefer to keep things simple.  I have irrfitmed thousands of lower lid procedures and have never had s patient complain of removing too much fat or asked for fat to be replaced.  This whole fat repositioning thing is being oversold.

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.

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. 

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

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.