Hollowness after lower blepharoplasty. Is this normal?

Usually transconjunctival lower blepharoplasty with repositioning of the fat bags is a very effective procedure but the result does depend on the amount of fat bags present, the technique used, and healing process.

The goal of the arcus marginalis surgery is to preserve the fat that makes a bulge in the lower eyelid and move it to the top of the cheek to provide volume as a living pedicle graft. When it works, it is wonderful. In some cases, the doctor over promises the effect of surgery and under delivers. It happens. In some cases, the surgery found very little orbital fat, removed skin and resuspended the lower eyelid. That leaves the tear trough relatively under filled.  In that case, the fillers can be very helpful. And yes, under those circumstances, you may have been better off simply having filler.  Generally I will recommend filler if I think it will successfully handle the lower eyelid and reserve surgery for those situations that can't be managed with filler.

It would be unusual to have significant hollowing after a lower lid fat repositioning unless you had very little fat to begin with.  In some patients we try to save and move whatever fat there is, but it still may not be enough to fill the tear trough.  In those cases some filler is helpful post-op.  

from your lower lid, yes, that is a normal outcome and why many plastic surgeons transpose fat (move it from the bag into the hollow/trough).  You can easily find out what was done if you get a copy of your operative report (which would not be a bad idea anyway if you move often) so you can find out... or you could just ask your surgeon too.

Hello Piper5,There is always a possibility after a fat transposition a hollowness could be present. This is something you and the surgeon have to discuss preoperatively and is predicated on how much fat there is to begin with. So it is not unusual to have to fill afterwards. Sometimes filling maybe a better option than surgery. Since I dont have pictures, it is hard to tell. In any event it is all fixable to give you the appearance you want. Discuss this with your surgeon. Hope this helps.Cheers,

Thank you for the question and hollowness is a risk of the procedure but an examination is really needed to see what the problem is.  So see your surgeon or other expert in the area and be evaluated in personDr Corbin

Dear Piper5, Generally with lower lid fat repositioning you should not have significant hollowing. If you had little fat or the fat was removed then this can cause hollowness. Speak with your surgeon regarding your concerns. Best regards, Michael V. Elam, M.D.