Is fat positioning not always needed with lower blepharoplasty?

I have a transconjunctival lower bletharoplasty scheduled in a couple of weeks. My doctor did not mention anything about fat repositioning. Is this something that should be done to reduce the risk of looking hollowed out? Also, he said because I am 31 I will not need a skin pinch, but we could use the laser down the road if needed? Will he know if he needs to use the laser right away. I don't want to heal only to find out I need another procedure.

Doctor Answers 9

Transconjunctival lower blepharoplasty- when to remove and when to reposition fat

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Thank you for your question. Photos would be helpful, however an in-person consultation is necessary to determine the best treatment plan for your unique needs.

The decision to transpose or remove (sculpt) fat is dependent on each individual's unique anatomy. When transposing, prominent fat is moved into the under eye hollows (the so-called tear trough) to add volume to this area. I use this to volumize these areas when necessary as this improves the contour of the junction between the lower eyelid and upper cheek. In younger individuals and those without significant depression of the year troughs, simply sculpting the fat is often all that is needed. Again it all depends on your unique anatomy.

I recommend you consult with a board certified facial plastic surgeon, plastic surgeon, or oculopastic surgeon who is experienced in eyelid rejuvenation.

Best of luck!

Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Fat removal lower blepharoplasty

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In our practice, we have been using the trans-conjunctival approach fat removal blepharoplasty for over 25 years with an excellent success rate. This involves making the incision on the inside of the eyelids.

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

Fat repositioning with transconjunctival blepharoplasty

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Without seeing a photograph, its hard to answer your question. However given your age, it is unlikely you have yet developed a tear-trough deformity that would call for fat repositioning.

Daniel Lensink, MD
Redding Oculoplastic Surgeon
5.0 out of 5 stars 4 reviews

Lower lids

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lynz007, no one can answer this question without an exam. I prefer using an approach known as the "SOOF lift blepharoplasty". You may want to research this on the Internet. See video and good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews


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The fat re-positioning really depends on your anatomy. Also, it is not uncommon for the surgeon to discuss the technique with generalities. This is a question you should ask your surgeon directly. They may not have used the term specifically but may be planning to do something similar. 

Tracy E. McCall, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 1 review

Is fat positioning not always needed with lower blepharoplasty?

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Agree, depends on anatomy and age in terms of what approach is used....discuss with PS , IMO Skin pinch is rarely needed when you have a  c02 laser available....good luck!

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Lower lid blepharoplasty

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Hello and thank you for your question.   Transconjunctival approach with fat removal or repositioning can be very effective in your age group.  The answer to your questions truly relies on your individual anatomy.  If you have found the surgeon you are comfortable with, then I recommend sharing your concerns and questions with your surgeon.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

Lower blepharoplasty

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It's hard to say much without doing an exam, or at least seeing photos of you. In general, there are many different techniques for rejuvenating the lower eye. The amount of volume depletion and/or presence of a tear trough deformity can often dictate which procedure is done, in addition to surgeon preference and experience.  I would recommend you direct this question to your surgeon and have an honest discussion about your concerns BEFORE going in for surgery. Good luck!

Justin Cohen, MD
Washington DC Otolaryngologist

Lower eyelid fat

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Fat in the lower lids can be excised, repositioned or left alone if there isn't much.  Talk to your surgeon, make sure he or she understands your concerns.  Good luck, Jane

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.