Why is a fat transfer recommended for doing my lower blepharoplasty? And what will happen if I don’t include that procedure?

Hi there,
I do believe there is a role for fat transfer in many patients.  It has nothing to do with ectropion, which is completely unrelated.
My feeling is that fat transfer is really useful in three situations:
1. Thin patients, particularly men, with really thin midface regions.  In this patients, pure removal of the fat can lead to a “long eyelid” look (think Stewey from Family Guy).  This is not a refreshing look.  Fat transfer keeps a little more volume in the lower lid and mitigates that risk,
2. Older patients with midface descent and unmasking of the bony eye socket rim.  The transferred fat can soften that bony contour.
3. Regular  patients with a lot of transconjunctival fat.  Sometimes the fat keeps flowing, and even with careful attention to the amount resected; it occasionally seems like a little bit of the fat comes forward postoperatively, leading to a little focal puffiness. By transferring the fat and “locking” it into position, that risk is reduced.

The downside of fat transfer is I find that it can lead to some low grade swelling for several weeks.  Patients are not overly bothered, as it is mild.  But definitely it prolongs the healing period a little bit.
Hope this helps
JDW

Many times an eyelid procedure is combined with fat injections if there is significant hollowing in the area. This improves a sunken appearance. Without it, you will get the result from the eyelid surgery but the volume may not correct. Hope this helps.

Great questions!
A transconjunctival (inside the eyelid) incision during blepharoplasty does have lower risk of ectropion (rolling out of the eyelid) when compared to a subciliary incision (under the eyelashes). However, this does not guarantee you won't have ectropion, but does lower the risk.
As far as fat transfer, this varies based on patients. The options you have are fat transfer from elsewhere in the body vs fat transposition which utilizes the fat already around the eye and repositions in areas that are deficient. Certain patients (very hollowed out or minimal fat) may be better candidates for fat transfer as there is not enough around the eye to account for the hollowing/tear troughs. There is alot of controversy because different patients benefit from different techniques and some surgeons prefer one over the other. I think you can get good results from either technique in the right hands.
Lastly, you can have fat transfer during or after blepharoplasty. Most would recommend getting this done at the same time to save you a second anesthetic/procedure, but it is not unreasonable to wait and see how things look before considering fat transfer. For fat transpostion however, this needs to be done at the same time as blepharoplasty as the fat pads must be visualized to reposition them.
Hope this helps!Kyle Kimura, MDFacial Plastic and Reconstructive Surgery