Is fat transposition to tear trough area the same as fat grafting to the lower eyelid?

Question

How much cost does fat transition to the tear trough area cost?

Robert Glasgold, MD, FACS · Answer

Fat transposition is the process of mobilizing the fat from the lower lid and draping it over the bone of the orbital rim to fill the lower lid hollow (i.e. tear trough).  The idea is to take fat from where there is an excess and move it to where there is a deficiency.  The theoretical advantage is that the transposed fat still has its blood supply and therefore it should all "survive" in the new location.  Fat grafting is where fat is harvested by suctioning out from a distant site (belly or thigh) and injected into the volume deficient area between the lower lid and cheek which causes shadowing (dark circles) under the eyes.  The fat graft does not have its innate blood supply when transferred but will eventually get a blood supply in the new site.  In the healing process we have found a range of 30% to 40% long term retention of the fat graft volume.  I have had experience with both procedures.  I no longer perform fat transposition, instead I employ fat grafting and when needed will combine this with removal of the excess lower lid fat (rather than transposing it).  Despite the perceived advantage of better fat survival with transposition there are significant limitations with the procedure.   Patients often do not have enough fat to be transposed to adequately fill the complete under eye hollow;  and even when it seems to be enough at the time of surgery, it will often be inadequate as healing occurs.  Both procedures have their limitations.  The best treatment will depend on what your lower lids look like, and what the surgeon you consult with feels will give you the best result.

Mehryar (Ray) Taban, MD, FACS · Answer

Lower blepharoplasty with fat repositioning is when the existing lower eyelid fat pad is moved into lower position to fill the tear trough area; it is still connected to its blood supply with great survival.  Fat grafting is when fat is harvested from another site in the body (example belly or thighs) and injected into other areas, such as lower eyelids; it is not as predictable or effective since it is a graft and does not have its blood supply.

Ran Y. Rubinstein, MD · Answer

TEAR TROUGH REJUVENATION OPTIONSSurgical Options:1.  Fat transposition:  during a lower excess lower eye lid fat is transposed into the lower lid hollows (tear troughs) rather than discarded.  Results are long lasting but the risk of ectropian (pulling down on the lower lid) is not worth the risk.2.  Fat grafting (fat transfer) is a much safer way to surgically restore lost volume under the eyes.  A lower eye lift approach is not required so its less invasive but there can be problems with resorption and lumpiness.  This should only be performed by someone who has extensive experience in fat grafting. 3. Tear trough implants are another surgical options.  These work well but require a lower eye lid or incision inside the mouth for placement and there is the low risk of infection.  There are the least popular options.Non Surgical Options:  1.  Hyaluronic acid fillers.  These are the safest and most predictable in tear trough rejuvenation.  There are different techniques.  If the product is injected too superficially, you can get a bluish discoloration also known as tindel effect.   This is more common with Juvederm vs. Restylane.  When performed properly, results often surpass that of fat grafting without the downtime.  Results are reversible.  I use a micro cannula for the injections which dramatically cut down the pain and bruising. 2.  Sculptra injections.  Although this is an off label use, Sculptra can restore lower lid volume beautifully with results lasting beyond two years.  The PLLA sugar molecules in Sculptra cause your own body to produce its own natural collagen and volume.  The sugar molecules are broken down by your body into CO2 and water an extracted in the urine leaving your own natural volume.  Three treatments are often needed.  Treatments should only be performed by an experienced injector as results are not reversible.Good luck.Ran Y.
Rubinstein, MD
200 Stony Brook Court, Newburgh, New York 
Board Certified Facial Plastic Surgeon
Clinical Professor New York Presbyterian Hospital
National Education Faculty (physician trainer) for: 
  Allergan (Juvederm, Voluma), Valient (Scultpra,
Restylane), Cynosure (Cellulaze, Precision Laser Lift)
& Solta (Fraxel, Thermage)

John J. Martin, Jr., MD · Answer

These are very different procedures.  With fat repositioning, the fat that is already present in the lower eyelid is moved into the tear trough.  For people with enough prolapsed orbital fat, this is a great way to fill in the trough.  If you are hollow, then you can do a fat transfer.  In this surgery fat is taken from another area of the body and placed into the tear trough.  Both of these procedures are difficult, so make sure you find a surgeon who is experienced in these surgeries.  I would recommend an oculoplastic surgeon as they specialize in the eyelids.

Jonathan R. Fugo, DO · Answer

Great question. Fat "transposition" to the tear trough is typically performed as part of lower eyelid surgery and involves moving fat from one area in the eyelid or cheek to another area of the eyelid or cheek. The fat is never "removed" from its general location, rather moved slightly. This is done to address the many signs of an aging lower eyelid and is usually not performed in isolation to treat a tear trough deformity. Regarding fat transfer or "fat grafting" to the tear trough, there are multiple things that deserve consideration. I preface this by saying that I do not recommend fat grafting to the tear trough to any of my patients for the following reasons: Fat grafting involves removing fat from one area of the body and transferring it to another, more desirable area. The time and expense of doing this procedure cannot be easily justified when comparing to filling the tear trough with readily available dermal fillers. Sure, you might say that "fat is permanent". This is true to some degree, but this does not mean that you'll never need it done again. Remember...your face and eyes are not static structures..they're constantly changing and aging. What may look good for you now won't be so in the future.Another significant downside of fat transfer to the face is the recovery. It has significant swelling and prolonged redness (inflammation) associated with it. This may take weeks or months to completely resolve.Lastly, keep in mind that the eyelid skin is the thinnest skin on the body. As such, it readily shows almost all imperfections. If fat transfer is not done "perfectly" you may be stuck with a result that you're not happy with. If placing the fat isn't difficult enough, removing poorly placed fat from the eyelids is extremely difficult.Compare all of this with the use of a Hyaluronic Acid filler. A few hundred dollars out of pocket and a 10-15 minute office procedure associated with little risk of bruising, minimal, transient swelling and no inflammation......seems like a no-brainer, right? Sure, there's a good argument that the procedure needs to redone every 6-8 months and this is less advantageous. Again, it's a personal calculation of risk-benefit ratio.Start by finding a Plastic Surgeon, Board Certified by the American Board of Plastic Surgery with experience in these procedures. Sit down for a consult. At the very least, your surgeon can review your options so that you can make a well informed decision on what makes the most sense for you. Best of Luck!

George C. Peck, Jr, MD · Answer

Fat transposition involves the moving of fat in one area and suturing it in an adjacent area without losing the blood supply to the tissue. Fat transfers involve harvesting fat cells by liposuction and therefore disconnecting the cell from its blood supply.The fat graft is processed and then injected to another area.Fat transposition is usually performed in a lower blepharoplasty procedure with the removal of eyelid skin.Fat transfers may or may not be performed in a lower blepharoplasty procedure.An Upper and Lower Eyelid Blepharoplasty procedure costs $4100 which includes the Board Certified Professional Fee, Board Certified Anesthesia Fee, and Medicare Approved Surgicenter. Hope this helps.

Louis W. Apostolakis, MD · Answer

The short answer is no, fat transfer and fat re-positioning are different.  Fat transfer involves liposuction from some other part of your body and then injecting that fat into the lower eyelid/cheek area.  Fat re-positioning is the process of using the fat that is continuous with your eye socket fat, freeing it up and moving it down to the tear-trough area.  This procedure keeps the blood supply to the fat intact where the liposuction and injection relies on the fat cells surviving without a blood supply at first.  Fat transfer has a fairly high failure rate because of the lack of blood supply and other trauma associated with liposuction/injection, in which case the fat dissolves and there is no ultimate change from pre-op.  With fat re-positioning there is more limitation as to how much fat is available and how far it can be moved, but survival is rarely an issue.Tear-Trough Implants are another option for filling the cheek/lower eyelid groove.  These have the advantage of more choice in volume of filling and that they never will dissolve or fail to "take".  They also won't change size with weight gain/loss as fat transfer will. There are a lot of details to discuss with these three approaches and a consultation would be needed to fully address those.

Barry Press, MD · Answer

The tear trough is the groove between the lower lid and the cheek that deepens as we age, fat from the lower eyelid begins to protrude, and the cheek soft tissues descend. The goal is a smooth transition between the lower lid and the cheek, and this can be achieved in a number of ways. See a surgeon certified by the American Board of Plastic Surgery to evaluate the most appropriate approach in your situation.Good luck!

Brooke R. Seckel, MD, FACS (retired) · Answer

You're being confused by the fact that many people call fat injection with a needle fat grafting.Fat transposition involves simply moving the fat still attached to its blood supply down into the tear trough area.  Open fat grafting involves a trans-conjunctival incision and harvesting fat and placing a composite in tact piece of fat down to the tear trough.  Than that effect of these 2 operations is the same.However make certain that the surgeon you are meeting does not mean fat injection when they use the term fat grafting.  Fat injection or fat transfer involves harvesting fat and then injecting the fat through a needle.  This destroyed is almost half of the fat cells and is frequently associated with lumps.  It is not the same as fat transposition an open fat grafting.

Ronald V. DeMars, MD (Retired) · Answer

Fat transposition is part of lower eyelid surgery and works very well. Fat grafting is different and unless done with great skill and experience can be very unsatisfactory.

Is fat transposition to tear trough area the same as fat grafting to the lower eyelid?

Answers (10)

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