This is a follow-up to my first question... titled: "Lower blepharoplasty with Negative Vector orbit?" During my consultations, I asked about repositioning the fat from the bulge to the crease under the eye, instead of removing the fat completely. I was informed the rate of success is not good for repositioning the fat. It is better to have the fat removed and than get fillers injected in that area. Is there often complications associated with fat repositioning under the eye?
Is Fat Repositioning During Lower Blepharoplasty a Common Procedure?
Doctor Answers 22
Fat repositioning or tissue rearrangement for lower eyelids
In about 95% of the cases I do tissue rearrangement or fat repositioning for the lower blephroplasty. It works quite well and is my preferred method of helping lower eyelids. Why throw tissue that is your own away and then put something foreign in? This is sometimes in conjunction with some midface suspension of tissues that help the thin tissues of the bony middle part of the face especially in negative vectors. You should seek out someone who does these procedures frequently like a board certified plastic surgeon member of the American Society for Aesthetic Plastic Surgery. Good luck with your search.
Dan Mills MD FACS
Fat repositioning in lower lid bleph
I sometimes use fat repositioning but also sometiems remove fat. It really depends upon the indfvidual and how they look.
Fat repositioning versus partial fat removal
Fat repositioning versus partial fat removal is very controversial in the field of facial cosmetic surgery. There is no consensus amongst surgeons as to what is the best technique, therefore seek 2 or 3 consultations in your area by surgeons who perform lots of blepharoplasty procedures for best results
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Fat repositioning in lower eyelid blepharoplasty is very beneficial
As an oculoplastic surgeon, in my mind, there is only a RARE patient that does not benefit from fat repositioning in doing blepharoplasty. Over the last decade, as surgeons, our experience has showed us that if too much fat is removed from the lower lids, patients generally wind up looking hollow or "skeletonized" with time. In almost all of my cases, I reposition the lower lid fat into the hollow area over the inferior orbital rim to improve the contour. In some patients, they may be so hollow that lower lid fillers may still need to be considered. There is no real increased complication rate, but as with all things, it depends on the surgeon and his/her experience. Please see the attached link for an article I wrote on the subject several years ago.
Jasmine Mohadjer, MD
Lower eyelid fat repositioning
this is a good follow-up to your initial question. Fat repositioning actually is a great maneuvered performed on someone like you. Not everyone is good candidate but a stunning photos and history are not a bad one. It's nice to have a little more fat to work with. I think most the time it is pretty successful but it's all about perception. The patient and the patient's friends and families will never really know the difference between having had repositioning versus simply having the fat removed. Fat repositioning is a good procedure to perform and it does create a nice improvement but it doesn't always have this wow effect that people have envisioned in their heads. Without it you undoubtably would look hollow after your surgery. But there's no way for you to really compare repositioning versus not repositioning. I tell all lower eyelid patients whether they're having repositioning procedure or other more standard floor eyelid maneuvers to treat bags that their optimal result may still be provided by an additional syringe filler or even fat transfer. The entire complex of the lower eyelid, the anterior cheek, and the lateral orbital rim is an interesting place that requires, much of the time, restoration of that entire area not just the lower eyelids if you really want to make a nice difference.
So to answer your question: fat repositioning good? Answer. Yes. That being said you want to find a surgeon who can show you actual photographs of that procedure. If they're doing enough lower eyelid surgery bill have various categories of before-and-after's to show you.
Fat Reposition rather than Removal in Lower Blepharoplasty
Modern Blepharoplasty has moved from removal to repositioning the fat for a very good reason. If the fat is removed, the eye begins to look hollow and skeletonized within a year or two as the aging eye continues to lose fat. Many surgeons continue to use the method they learned because it is easier. However, the rest of us have continued to modify our technique to improve our results. The success is excellent if one understands the anatomy and has modified the procedure to accommodate the moved fat and suspend the lid to prevent complications. Having fillers to replace the fat removed makes absolutely no sense, since the best filler is your own fat, and artificial fillers are expensive. Besides, injecting the tear trough is one of the most difficult areas one can inject.
Fat repositioning with a blepharoplasty.
I do this procedure of fat repositioning with a blepharoplasty commonly in my practice. If the patient is getting sufficient elevation with a cheek lift then it is not necessary. Otherwise this is a common procedure using the fat from the mountain to fill in the valley with a blepharoplasty.
Lower blepharoplasty with fat transposition
Lower blepharoplasty with fat transposition (or repositioning) is an excellent effective procedure to accomplish two goals: 1) reduce the bags/fat of the lower eyelid; 2) to fill up the hollow dark circles. Done correctly, it is very safe and effective. See an oculoplastic surgeon familiar with the procedure.
Fat repositioning and cheek lift surgery for lower eyelid rejuvenation
In most patients with changes of aging around the cheeks, the cheek has dropped considerably.
We've found it is usually best to elevate the cheek via a cheek lift and reposition the fat rather than just reposition the fat. Then, the cheek with its fatty tissues is positioned higher and can hide lower eyelid hollowness.
Fat repositioning is not a common practice by any means, and still quite controversial, particularly procedures which involve division of the orbital septum or tightening of the septum.
It's best to select a surgeon with an interest in the mid face / cheek lifts.
Is Fat Repositioning During Lower Blepharoplasty a Common Procedure?
Fat repositioning is very effective for the properly selected patient. Some or all of the lower eyelid bag is repositioned into a position that fills the undereye hollow. It can create very nice results for both the lower eyelid and undereye hollow. Someone who recommends removing excess fat and then replacing volume with yearly filler treatments is, unfortunately, not doing you any favors. You might consider seeking a second (or third) opinion if that's the advice you're receiving. I hope this information is helpful.
Stephen Weber MD, FACS
Weber Facial Plastic Surgery
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.