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.

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