Lower Blepharoplasty: Fat Transfer or Repositioning, which method is preferred?

Lower blepharoplasty with fat repositioning is much more predictable than fat injection because the blood supply of repositioned fat stays the same and the fat always survives whereas the blood supply of fat grafting is completely taken away and the newly injected fat has to survive by getting new blood supply which is not always predictable. Sometimes, repositioned fat may not be enough and additional injected fat or filler is useful adjunctive procedure. See an oculoplastic surgeon.

Hey Liveyourdream- thanks for your question

This is a very difficult question to answer for you without a physical exam or some detailed pictures. With the three procedures that you mentioned, Bleph, Bleph with fat repositioning or fat transfer is trying to accomplish 1 goal: we want a smooth and natural transition between the eye and the cheek. 

Fat pseudoherniation protrudes and causes to shadowing or tear trough formation- if this is your problem and your mid facial volume is sufficient- a simple bleph with conservative fat removal is perfect

For hollowing or a "negative vector" where the eye sits anterior to the orbital rim- then fat repositioning is by far the best for the reasons already mentioned by my collegues- can't beat it!

It's best to really identify what bothers you - occasionally nonsurgical methods can be used to pinpoint and treat your concerns!

Have a great one!

Dr. Robb

Fat transposition is an excellent way to conserve the volume around the eyes when a lower blepharoplasty is performed. However, if you also have facial volume loss, in the cheek or other regions, then the fat transfer may be the better option. I often combine the two procedures to get the best results.An in person consultation with a surgeon that is experienced in both techniques would be the best way to determine which option (or maybe both) is right for you. 

Fat grafting, micro fat grafting, nanofat grafting, call it what you want are damaging procedures performed by surgeons who do not understand the harm they are doing.  Grafted fat causes inflammation and scaring. Unfortunately the unique feature of the lower eyelid/cheek junction is that they are composed of glide planes.  Grafted fat scars the glide planes.  This gums up and harms these tissues rather than helping them.  I see 2 to 3 new consultations each week of people who have problems after having had lower eyelid fat grafting.  Be careful what you look for.

If you have enough fat in the lower lid, repositioning that would be the best option.  It is rare to see contour abnormalities from the repositioned fat.  If you don't have enough fat to fill in the tear trough, then you could consider HA fillers post op, or fat.  Fat is tricky in this area, and can sometimes produce nodules of firm fat which have to be removed.  But when all goes well with fat transfer it can look great too.  Find someone who does a lot of these surgeries as they are not easy to do. 

Each Doctor has their preferred method and it also depends on you and desired results. Also, it's difficult to answer without a picture. That being said, there are some great non-surgical options too. Fillers, lasers, and microneedling/PRP can improve under eye hollows. We use PRP and stem cells there often along with fat injections if you are a candidate. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer.

In my opinion, there are several reasons why fat repositioning is better. First, fat repositioning keeps the fat on its original blood supply which means you can expect the fat to survive where you put it. Another reason is that the fat is already there, so why not use it! In surgery, it is better to use tissue which naturally wants to be there, so eyelid fat would be best for the eyelid. Fat transfer usually takes fat from another area of the body such as the abdomen. This means you have a second operative area which increases your risk of complications and contour deformity and scarring. Fat transfer is also less reliable since the fat is removed from its blood supply and waits for new blood vessels to form after grafting. A certain percentage of fat will therefore not make it and will be resorbed by the body which makes the procedure more unpredictable.  Hope this helps!!Johnson C. Lee, MD Plastic Surgery

There are a number of time-tested ways to resolve lower lid abnormalities, from removal of fat, to re-positioning of fat, to addition of fat via fat transfer. All have their place in aesthetic surgery. Depending on your specific concerns as well as the expert opinion of your surgeon, you could settle on any combination of the above. Its important to make sure you and your surgeon are on the same page. If you are, then trust your surgeon with his or her recommendation

The most important consideration when you are trying to avoid the hollow look, is to be very conservative with removal of fat from the festoons (this is the fat that is bulging out); whether you then redrape or transfer(graft) the fat over the area that is hollow below the festoons is debatable; no report has determined which technique is superior; In summary, the most important consideration is to minimize the amount of fat removed from the bulging region so that you don't create another hollow.