When will surgeons learn to undo lower blepharoplasty with excessive fat removal?

Question

Typical groove above the orbital rim and orbital muscle roll, visible even without smiling - fillers and liquid fat seem to not work for this unlike usual tear troughs (I don't see results in medical literature). However, I've seen convincing results in Raul Loeb's 1989 book and on the late Dr. Meronk's website - both used pearl fat grafts behind the septum. What have prevented this procedure from becoming widespread and is there any hope to solve this in the near future?

Mats Hagstrom, MD (license on probation) · Answer

Trying to master a plastic surgical procedure without having plastic surgery, background or training is a bit futile.
In order for fat transfer to be successful, there has to be a sufficient supply of host tissue to support the grafted fat.
Simply, placing fat behind the orbital septum is insufficient to allow the grafts to survive.
Fat transfer will not work unless the fat is correctly, grafted into sufficient viable host tissue.
This is one of the basic principles of tissue grafting.
 This is the same reason. Skin graft will not survive over tissues, like exposed, bone, or tendons.
My best response back is that each surgeon is responsible for the outcome of the surgical. Procedure and patience are responsible for selecting that provider.
I continue to encourage people to be careful when selecting providers and always recommend patients have multiple in person consultations before selecting a provider and considering scheduling surgery.
 Being board-certified and plastic surgery with years of experience, does not mean somebody has mastered any single procedure.
During each consultation, ask each provider to open their entire collection of before, and after pictures of previous patients, who had similar characteristics to your own.
Being shown a handful of pre-selected images, representing only the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
This is also true when seeing case reports or single examples, published by authors.
 Without knowing what average results look like it’s difficult to ascertain success of anyone single procedure.
The biggest mistake. Most patients make is scheduling only one consultation which more or less eliminates the ability to choose the better provider.
I recommend patient avoid the temptation of making their own assessments and prescribing their own procedures.
There’s an expression in medicine that says “ the doctor, who treated himself as a fool for a patient”
I recommend patients rely on the expertise of those who have a proven track record of having the greatest skill and amount of experience in the field.
Some situations are inherently difficult, and may not be possible to treat.Best,
Mats Hagstrom, MD

When will surgeons learn to undo lower blepharoplasty with excessive fat removal?

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When will surgeons learn to undo lower blepharoplasty with excessive fat removal?

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