What are the differences in results and benefits for doing fat repositioning versus a fat transfer? What are the pros and cons?

Hi and thank you for your question! Fat repositioning is a technique that is used in lower eyelid surgery to fill hollow areas in the tear trough region of the face. The advantage of this technique is that it uses fat cells already native to the lower eyelid, and there is no additional donor defect created in the harvest of these fat cells.  If there is not enough fat in the postseptal space to fill the volume defect then fat transfer may need to be performed in addition to, or instead of, fat repositioning.  The fat that is transferred for this procedure is usually harvested from the lower abdomen, flanks, or thighs. Whereas fat repositioning is done in the postseptal space, fat transfer is performed at multiple levels in the soft tissue between the skin and bone in the tear trough region to try to insure smoothness of placement and maximization of survival of the transferred fat.  I recommend choosing a board-certified plastic surgeon with expertise in eye rejuvenation for your treatment, who will tailor your procedure to your precise needs and goals. 

There is a great deal of various procedures offered for this condition. Repositioning of fat involves taking the lower lid fat and transposing it to the deficient area. The problem with this procedure is that the fat can retract and create a buldge.Fat transfer can be very effective and is my preferred method.Filler is temporary but may be a good option to determine if you like the results before moving to something longer lasting. Hope this helps.

Thank you for a phenomenal question. Assuming that you have a tear trough deformity, the first thing that we need to establish is why is it there. A careful examination can determine what is the defect and what is due to existing fat. Sometimes, the answer is simply to remove the excess fat. If the skin is adherent to the orbital margin (bone), lifting the tissue and repositioning the fat to fill the void is an excellent choice. If there is inadequate periorbital fat or you've had a prior blepharoplasty, then fat transfer can be performed. If you want a non surgical option, fillers can be used too. To some degree, the surgeon's preference is based on experience. If they're particularly good at something, that is what they like to do. Each option does however have different benefits and risks. A lengthy discussuion is beyond the scope of this posting. As in any procedure, it all begins with a diagnosis and careful examination. You can expect to be presented with reasonable options and a discussion of your particular risk factors. Make your decisions carefully.

Dear lisa.777,All are reasonable options, and the best choice depends on the experience of the surgeon and the patient's anatomy.Best regards,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons
Fellowship-trained Craniofacial Surgeon

Either is acceptable if done correctly.   I think that you will find that this is a function of training and preference and not quality of result.  

Fat transfer results are permanent, but not all fat will survive. Harvesting is important to fat transfer. Yes, I use water-assisted fat harvesting which gives pure fat to transfer and combine with platelet rich plasma (PRP) to get the most viable and sustainable fat cells. This can be combined with Sculptra, depending on treated area, to improve outcomes. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Fat repositioning, fat transfer and injectable fillers can all be effective ways to manage volume loss in the periorbital area.  Which to use depends on the amount of correction needed and whether other procedures are to be done concurrently.  If I am doing a lower eyelid blepharoplasty and the volume correction is in the tear trough I find fat transfer to be the most reliable method as all the fat retains its vascular supply and lasts long-term.  In patients needing greater volume correction in the midface or not having eyelid surgery for another reason, fat transfer or injectable fillers are better options.

This is a great question. I prefer fat repositioning to fat transfer because the outcome is more predictable.  When I reposition the fat, I'm doing less harm to the fat causing it to stay where it's positioned causing a smooth outcome for the lower eyes.  If I were to transfer fat from somewhere else in the body to your under eye, I have to count on that fat surviving the transfer.  I prefer to be able to predict the outcome better than hoping the fat transfer is accepted by the body.  Be Well! Michael Macdonald, MD, FACS, FRCSC

Fat is being used more and more in the lower lids to correct tear troughs and grooves that sometimes are made worse with fat excision alone.  Whether it is fat from the eyelid itself vs fat harvested from elsewhere and injected with a cannula is up to your surgeon.  I like to use eyelid fat to fill in these areas and avoid fat grafting unless you need volume in your malar eminence to correct a negative vector. 

An aesthetically pleasing shape is something many of us desire and while proper nutrition, exercise and weight control are very important, sometimes we cannot achieve our goals. Simply getting older and pregnancy also play a role in the appearance of our bodies. 
If you desire the most dramatic improvement, then a full lift can help you achieve your goals. This removes excess fat and skin, and tightens  muscles. However, a mini lift or just liposuction are very good procedures and many patients are happy with only these surgeries.

Any of these procedures can be improved with fat injections.  In general, someone has to have fat for us to be able to perform liposuction on it and inject it into a different area of their body. Please remember that typically about 30 to 50% of fat survives when it is injected. Additionally, not all the fat that is removed can be injected. It is important to have realistic expectations. If they do not have enough fat, sometimes I will even tell a patient to try to gain some weight so we have more fat harvest if this is important of them. It really depends on your specific examination. There Are usually many options. 

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of tummy tucks and body contouring. Good luck with your future surgery!

I hope this helps answer your question.  If it does, please take a moment to up vote this answer on the “respond” button on the top right. 

There are many options for improving the cosmetic appearance of the lower eyelids; fat repositioning, fillers, and fat transfer are just some of them.
Fat repositioning involves moving the lower eyelid fat bags into the hollows so that you have a smoother lower eyelid-cheek junction contour. The fat has a pedicle, which means it has its own blood supply, and this is beneficial because it optimizes the survival of the fat.
Fat grafting to the eyelid hollows involves taking fat from another part of the body and injecting it into the hollows. The fat does not have a pedicle, so it relies on the blood supply of the area it is being injected into. This  does not optimize the survival of the fat , and therefore the results may not be as predictable. 
Fillers are not permanent, but the results typically do last longer in the eyelids. Many argue that fillers are only good for patients that only have hollows and don't have fat bags, but our practice has used fillers to not only volumize patients who are hollow, but to also camouflage the fat bags. 
In regard to avoiding a post-surgical hollowing, volume preservation is best in my opinion. 
In regard to avoiding post-surgical eyelid ectropion and retraction, there are many things one can do to reduce the risk which is beyond the scope of this forum, but by and large these include undergoing transconjunctival blepharoplasty (versus transcutaneous) and avoiding external excisions better preserves orbicularis oculi muscle (eyelid muscle) function, avoiding trauma to the orbital septum, careful surgical technique, and avoiding excess skin removal.