I'm getting a lower blephproplasty soon. I'm concerned about a hallowed out look after fat pockets are removed.

I'm getting a lower blephproplasty soon. My surgeon says that I just need to have the fat pockets removed by incision on the inside of the lower lids. He says that the skin will just go back into place and not sag because I don't have any wrinkles yet. Could I have an opinion on this? I'm also concerned about a hallowed out look. How is the hallowed out look avoided? Does it depend on the shape of each persons eyes? Thank you in advance.

Doctor Answers 5

Excess removal of fat from the lower lids can create a hollowed out appearance.

Your concerns are valid and you should choose surgeon who will conservatively remove the fat or redistributed to an area of need. Make sure that you see lots of pre-and postop photographs.

Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Lower eyelid blepharoplasty incision

The primary goal of lower blepharoplasty is to remove a conservative portion of the 3 fatty compartments in the lower lids. The lower eyelid fat is removed through a trans-conjunctival approach. This removes the puffiness look. When patients are over 50 and had excess wrinkles, then a pinch technique can be performed on the outside of the eyelids at the lash line. This incision is closed with tissue glue.   isIn our practice there are no stitches used on the lower lids.  For many examples, please see link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Hollowed out look after lower blepharoplasty

A conservative fat removal using transconctival (inside eyelid) with or without skin pinch removal should not cause a hollowed-out look. It can greatly improve your eyes and take away the tired look that many patients have from puffy under eye area. Many times adding fillers to certain areas (i.e, tear trough) will better contour your lower eye area. This can be done 2-3 weeks after the surgery. 

Kyle S. Choe, MD
Virginia Beach Facial Plastic Surgeon
4.7 out of 5 stars 37 reviews

Hollow look after lower blepharoplasty

You are correct to be concerned.  Over resection of fat from the lower eyelid can certainly create a Hollow look.  You need to discuss this in detail with your plastic surgeon and insist that only protruding fat that is causing a puffy eyes or eye bags be resected and it over resection not be done.

In younger patients with no loose skin the trans-conjunctival blepharoplasty can be done without skin resection.  However if you have any loose skin at all some skin resection may be required.  This can often be done through a small incision on the side called a "skin pinch blepharoplasty".  Please see your plastic surgeon again and discuss all of these details thoroughly.  Once surgery is done at cannot be undone.

Less is more.

It can be difficult for surgeons to exercise restraint.  The surgery is not a fat removal surgery.  It is a eyelid sculpting surgery.  For this reason less fat remove rather than too much fat removal is the correct approach.  For this reason, arcus marginalis release surgery has become very popular where rather than removing fat, lower eyelid fat is moved to the top of the cheek to reduce the under eye hollow.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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.