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

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.  

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.

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)