Fat repositioning vs fat removal from lower eyelids. Which is best for me? (Photo)

I am an oculoplastic surgeon and I’ve been practicing in Manhattan and
Long Island for over 20 years. Cosmetic lower eyelid surgery is probably the
most common procedure that I do in addition to several other specialty areas in
our practice.



The concept of transposition of fat has a natural appeal to the lay
person. Doctors who very openly advocate for it appeal to this intuitive belief
that taking out fat can make patients hollow, so they take the fat and move it.
The similar logic was used a few years ago by another set of doctors who
believed that the best way to treat under eye bags was to take fat from another
area and put it under the eyes.



As a specialist who takes care of a lot of complications, I’ve seen
transposition patients who have had lumps and irregularities below the eyelid.
Chronic swelling is also very common and that is very hard to live with. These
patients needed me to revise their surgery.
I advise that you choose a procedure that’s predictable and will allow
you to get back to your normal life.



In my hands, I would not do transposition but a transconjunctival
blepharoplasty for a patient like you. It means going behind the eyelid to
address the under eye bags. I would sculpt and reduce the fat so it doesn’t
protrude and create a bulge. I would also use adjuvant treatment such as
platelet-rich plasma (PRP). This is derived from your own blood and we use it
routinely to help stimulate and improve skin quality. It also addresses skin
texture and dark circles under the eyes which are all interrelated. Once that’s
done, most people go back to work in less than a week. I perform these
procedures under local anesthesia with LITE™ IV sedation, so you avoid the complications
and long recovery time associated with general anesthesia.



The doctor who recommended transposition is not necessarily wrong. There
are many patients who came to me for a second opinion after they had
transposition. I reviewed their operative reports and saw no evidence of
transposition. It doesn’t mean that the doctors didn’t do it, but they tried to
do it and the fat just retracted back to its original position.



When I assess patients, I also look at the big picture and the interrelationships
of volume in the eyelid to cheek junction. I also look at volume in the malar
and sub-malar area. I always emphasize that the whole is greater than the sum
of its parts. There is no surgery that serves all issues. For many male
patients, taking away the negative of under eye puffiness is satisfactory
enough for them. I suggest that you think this through
and discuss this again with the doctors. I hope that was helpful, I wish you
the best of luck, and thank you for your question.



This personalized
video answer to your question is posted on RealSelf and on YouTube. To provide
you with a personal and expert response, we use the image(s) you submitted on
RealSelf in the video, but with respect to your privacy, we only show the body
feature in question so you are not personally identifiable. If you prefer not
to have your video question visible on YouTube, please contact us.

I recommend removal of the fat.  Fat repositioning is a lousy procedure with inconsistent results.  You should simply have the fat removed either from an internal or external approach.  It is really difficult to remove too much fat.

Let me start by saying, you asked the perfect question. Which is, which procedure is right for me? There are many variations on lower eyelid blepharoplasty, and each person has unique issues that determines the best variation for him or her. It is important to find a surgeon who has extensive experience with Island surgery to ensure that you are receiving the most customized care for you. Next, I would be very cautious in deciding on any lower eyelid surgery. From the photos you posted, it looks like your issue is overwhelmingly due to a lack of volume (both fat and bone) below the eyelid, and not due to excess eyelid fat. in my practice, I would recommend volume augmentation, a treatment of filler such as Restylane, which and right hands could give you an excellent result, softening the shadowing and hollowing of the lower eyelids.