Lower Blepharoplasty with Fat Reposition, are external sutures necessary?

Question

Are external sutures necessary in a lower blepharoplasty with fat repositioning (i.e. are there sutures which are visible in the lower eyelid after the surgery)?

Ronald J. Edelson, MD · Answer

if you have fat repositioning, which I think is a lousy procedure,  you will at least have skin sutures which need removal.  But don’t get fat repositioning.  The results are hit or miss and you will likely need to go back eventually to have the fat removed,  which really should have been done the first time.

Ali Ghafouri, MD · Answer

It all depends on the surgeon, his/her preference and the techniques used. The lower eyelid fat can be repositioned and secured by placing internal or external sutures at the eyelid-cheek junction. As always personal consultation with an experienced surgeon is crucial.

William Portuese, MD · Answer

It is very difficult to hold fat in place with sutures, so we perform a conservative fat removal thru a transconjunctival approach, on the inside of the eyelids

Mehryar (Ray) Taban, MD, FACS · Answer

Not exactly. Typically, there is a knot only that holds the transposed fat to the skin temporarily without actually cuts. See following surgical video (graphic) and website link.

Kenneth D. Steinsapir, MD · Answer

To reposition fat into the top of the cheek and provide help for the top of the cheek, it is necessary to advance fat from the lower eyelid into the top of the cheek.  To keep the fat there, full thickness stitches are used.  The stitches can be removed after about 5 days.  The sutures are visible but come out early.  You are still pretty beat up at this point and most people are not doing anything social at this point after surgery.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation. Fat transposition of the lower eyelid can be performed with a number of different techniques.  Transconjunctival fat transposition can be performed with no extrernal sutures, but it depends on your anatomy and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Ashish K. Jain, MD · Answer

many patients are not great candidates for trans-conjunctival (internal) eyelid surgery.  the technique is highly dependent on the surgeon and your anatomy.  if no skin needs to be removed you may be able to have an internal surgery. let your surgeon advise you on this.  best of luck

Steven Wallach, MD · Answer

Some surgeons place external bolsters to hold the fat in position. This is often taken out a few days after surgery.

Mark L. Mazow, MD, FACS · Answer

There are many methods to perform a lower lid blepharoplasty . The technique used should be tailored to the individual's anatomy and the desired goals. If an arcus marginalis release is done with fat transposition sutures are really necessary to held the fat down over the cheek. Either dissolving sutures can be used or sutures can be removed after 5-7 days. There is still a great deal of swelling and brushing at this point and should cause no cosmetic issue.

Justin P. Martin, MD, FACS · Answer

Thanks for your question.  I use the external sutures that you're referring to because I feel that it is the most reliable way to make sure that the fat stays in its appropriate position.  I remove the sutures after about 5 days, and have had excellent results with no resultant scarring from the sutures.

Lower Blepharoplasty with Fat Reposition, are external sutures necessary?

Answers (18)

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