What is the difference between a lower bleph which repositions fat and a soof lift?

What is the difference between a lower bleph which repositions fat and a soof lift?

Doctor Answers 4

What is the difference between a lower bleph which repositions fat and a soof lift?

Hello milliemils9 - Thanks for your question. A lower bleph that repositions fat is used to fill up hollowness in the tear trough deformity. I use it in patients who have sunken cheek bones and mild protrusion of fat vs. actual excess fat. Using an incision from inside the lower eyelid, each fat pad is dissected free on a healthy blood supply. The fat pad is then placed into the tear trough hollow as filler after arcus marginalis release. It is held by tethering sutures for 1 week until the fat can stay in place on it's own. Great care has to be taken to avoid injury to the fat. Risks for the procedure include partial resorption, asymmetry, nodularity, muscle injury, and eye/vision injury. A SOOF lift is a procedure where the sub-orbicularis oculi fat (SOOF) pad is elevated and anchored to the orbital rim periosteum. It is a procedure that is performed to elevate the cheek mass in more of a mid-face lift. Both procedures are capable of masking a lower eyelid hollowing seen typically in thin patients with midface bone loss. A fat repositioning procedure fills in the hollowing closer to the nose, while the SOOF lift fills in the lateral hollowing and pulls on the nasolabial fold resulting in it's softening. 

I hope this helps. 

Dr. Shah


Denver Plastic Surgeon
4.8 out of 5 stars 47 reviews

Fat transposition vs SOOF loft

In a lower blepharoplasty with fat transposition,  excess fat from the eyelid is draped "downward" over the rim of the eye socket to fill the tear trough. In a SOOF lift, "fallen" fat of the cheek is brought upward to fill the tear trough. Both procedures attempt to correct the same problem – dark circle under the eye. Both procedures attempt to correct the same problem – a dark circle under the eye.

I personally do not use either procedure. I believe removing the excess eye bag fat, and performing free fat transfer to the tear trough and entire cheek region, creates the prettiest result.  This is because very little fat is available to recycle from either of those procedures, and where it can be placed is very limited. Free fat transfer allows me to place more fat, and place it in areas that neither fat transposition or SOOF lifting can reach. 

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 170 reviews

Eyelid surgery and fat techniques

Both a SOOF lift and a fat repositioning are lower eyelid techniques to fill the tear trough with fat. The difference is whether you redrape the fat downward or pull the fat up. In the end, the effect is the same. The surgeons choice should be based on whether you have extra fat in the eyelids to redrape or not. Fillers are an alternative to fat based surgery. 

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

A world of difference.

Repositioning fat with a lower blepharoplasty is a procedure called an arcus marginalis release.  Fat from the lower anterior orbit, which fills the lower eyelid is mobilized and repositioned into the top of the cheek.  The idea is to reduce fullness in the lower eyelid bag area where it is not helpful and move it to the under eye circle area to fill the hollow here.  The results can be absolutely amazing in the right person.  SOOF stands for suborbiclualris oculi fat.  It is a really part of the investing fat of the cheek.  Generally due to how these are performed, they are remarkable unsuccessful and disappointing.  So caution is advise in considering a SOOF lift.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 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.