Fat repositioning under the eyes? (Photo)

Its best to provide a photo with your eyes in neutral position. The sulcus below the fat compartment is always accentuated with the eye gaze up position. Once that is seen, you may not need a bleph but only a filler. Otherwise its best to have a personal consultation.

When one looks up, it exaggerated the appearance of the lower eyelid fat contour. That in no way means that you need lower eyelid surgery. That fat needs to be there. How often do we walk around looking up in extreme up gaze? We don't. What is important is what is going on looking straight ahead. You posted such a picture in a July post. Looking straight ahead, you don't demonstrate the type of issues that benefit from lower blepharoplasty, with or without arcus marginalis releases (doctor speak for fat transfer). Don't talk yourself into surgery you don't need. There is no substitute for a detailed personal assessment to determine what bothers you and the basis for those concerns. I do notice that you carry your eyebrows at a very high position and wonder if that is hidden a latent upper eyelid ptosis. That is why I insist on personally meeting with patients and refuse to make surgical decisions based on "zoom consultations." Your eyes can be your best feature.

Definitely the ideal treatment is transconjunctival lower blepharoplasty with repositioning (not removal) of the eye fat bags to surrounding hollow area. Expertise is critical.

Lower mid blepharoplasty can be performed with a variety of techniques successfully so I would base your choice of surgeons based on experience reputation credentials reviews before and after pictures and your comfort with the surgeon. Your primary problem is not excess fat but a sharp demarcation between orbital and cheek fat. The partition needs to be released and fat either repositioned or fat added to valley or some combination.

Depending on the situation, fat repositioning as well as fat removal may help smooth your lower lids.
This is typically an outpatient surgical procedure. You should select a facial plastic surgeon and discuss your options in detail. Best wishes to you as you pursue your treatment.

Thank you for the photos. Both filler and surgery can be used for your particular situation. The quickest and simplest solution would be to have hyaluronic acid fillers such as Restylane to your lower eyelid area to smooth and lighten the shadows from hollowing in the area. There is minimal downtime but it will last for less than a year before you need more filler injected. For permanent results, you can have the excess bulging fat removed through small incisions behind the eyelid and have the fat repositioned as well so that the transition between your eyelid and the cheek is as smooth as possible. I always use the fat to fill in the tear trough as everyone will eventually need it as we get older and continue to age. There is also a greater amount of downtime with surgery and fat repositioning/grafting - you can expect to be bruised and swollen for a few weeks but it is more of a permanent fix. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon​

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary fillers, micro-fat grafts, blepharoplasties and combination of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty and micro-fat grafts to the tear trough depressions will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you exactly what to do and technically how to do it without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) . You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

A full set of facial photographs looking straight into the camera are going to be required to make a determination about how best to proceed. Looking upwards accentuates the fat bags more than when looking straight ahead. In our practice, we perform a conservative fat removal through a trans-conjunctival approach on the inside of the lower lids. If you have allergies, make sure they are under control before undergoing surgery

Thank you for the question and photo but an examination is really needed so go on some complimentary consultations with experts and compare recommendations after a full examination and discussion of desired results and look at photos of similar patients and become fully informed about the desired procedure

Dr Corbin