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

Question

When performing a Lower Blepharoplasty, which method, fat transfer or fat repositioning is better down the road to prevent the hollow look? In what case would it be better to perform neither & just the Lower Blepharoplasty? Thanks in advance for your answers, it's much appreciated.

Mehryar (Ray) Taban, MD, FACS · Answer

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.

Philip K. Robb Jr., MD, FACS · Answer

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

A.J. Amadi, MD · Answer

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.

Kenneth D. Steinsapir, MD · Answer

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.

John J. Martin, Jr., MD · Answer

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.

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

Answers (9)