Am I a candidate for lower bleph w/ fat repositioning? I'm getting different opinions! (photos)

Question

I've consulted with 3 oculoplastic surgeons and 1 aesthetic nurse injector and all but 1 of the oculoplastic surgeons said I'm a candidate for lower bleph + fat repositioning. One of them suggested I wait until I'm 40 (I'm 36 now), and that I was not a candidate for him yet. I would love to hear more opinions. I want to make sure this procedure is right for me before I pull the trigger and either have another consultation or schedule the surgery.

Gianfranco Frojo, MD · Answer

I think you are a fantastic candidate for transconjunctival lower eyelid blepharoplasty and facial fat grafting to the lid-cheek junction. I would recommend seeing a REAL PLASTIC SURGEON certified by the American Board of Plastic Surgery with experience in periorbital surgery. Oculoplastic surgeons are ophthalmologists who did a one year fellowship in "oculoplastic surgery".

Donald B. Yoo, MD, FACS · Answer

Common reasons for lower blepharoplasty include tear trough deformity or pseudoherniation of the orbital fat. An in-person exam would provide a more accurate diagnosis. Transconjunctival lower blepharoplasty with fat repositioning will provide nice results and a better lid-cheek transition in this case. If you want the best idea of what is possible for your eyes do your due diligence, find an experienced surgeon, and have him/her evaluate you in person and discuss your options. #drdonyoo

William Portuese, MD · Answer

In our practice, we do not perform fat trans-positioning on the lower lids for a variety of reasons,  since it just doesn't work very well. A simple, trans-conjunctival approach Fat removal from the inside of the eyelids is all it would be required under a brief general anesthesia.

Mats Hagstrom, MD (license on probation) · Answer

This is an anatomically tricky area to work in both in regards to making quality assessment and treatment.
As you probably know, there are two changes that happens to some as we get older in this part of the face. 
In the youthful face, the lower eyelid should be tight and snug with immediate plump fullness in the upper part of the mid face.
As we age the two volumes reverse with bulging of the lower eyelid, fat pads and loss of volume in the upper part of the midface.
I find it helpful to first differentiate which of these is primary and which is secondary.
lower eyelid fat transposition may seem like an ideal procedure since it essentially fixes both problems.
The problem lies in execution and getting the fat to sit exactly where it should. The outcome of this procedure is not always as predictable as we would like. 
I suggest carefully vetting providers by insisting they they show you a complete collection of before and after pictures of previous patients who had similar characteristics. 
Everyone will have a handful of good results. The question is what do average results look like. How many patients are discontent with their outcome? How many patients end up having revisions? 
Ask providers to show you a variety of outcomes. We all have them. Ask to see outcomes of patients that did not turn out as well as the surgeon had hoped. Ask to see the good the bad and the ugly. 
Providers may be reluctant to show complications or results they are not proud of but these are the pictures patients should see if they want to have a clear understanding of what typical results really look like based on your candidacy. 
There are also different approaches to take for the same situation and fat transposition has its drawback like all procedures. 
For reference consider looking at the website of Dr David Mabrie,MD in San Francisco. He is a facial plastic surgeon who does only fillers. His work with volume restoration is the best I’ve ever seen. 
If one procedure was truly superior then we would all be doing it. Getting fat transposition to look as good as proper volume restoration may be challenging. Moving or removing too much fat can also create a surgical unnatural look in some individuals.
There are NO guarantees when having cosmetic surgery. Patients are nutritiously bad at selecting providers and often make decisions based on variables that turn out to be less significant than they thought. 
In the end my best recommendation is for patients to be more selective than they may think is necessary. 
To vet providers insist that they show you a significant number of results. 
In my opinion, an experienced provider should have no difficulty showing you the before and after pictures of at least 50 previous patients for commonly performed procedures.
Highly experienced surgeons should in fact have access to hundreds or preferably thousands of before and after pictures to choose from.
This is what patients should be looking for. 
A collection of before and after pictures that reads like a telephone book. I suppose a lot of people have actually never seen a phone book. 
I would also like to point out that providers who are strong self promoters, and drive large social media and advertising campaigns are probably not the providers you want doing your surgery.
The best plastic surgeons, I know are busy taking care of patients and spend virtually no effort promoting their practice. 
I would also be reluctant of providers who seem to have excessive numbers of reviews. At a minimum don’t exclude providers to don’t stand out on google searches. High numbers of reviews usually come from patients who are incentivized or worse. 
I know who is paying the most for google adwords in my community and they are not the surgeons I would want operating on me. 
In the end sometimes it’s just a matter of luck. 
It’s not wrong to go back and have a follow up visit or follow up consultation especially when considering permanent and irreversible aesthetic procedures. 
If in doubt slow down and schedule more consultations.
No one has to have cosmetic surgery. 
I also am a big believer in letting doctors do the doctoring and resist the temptation of making our own assessments or prescribing our own operation. 
Fat transposition is not wrong but it is only one of several ways on managing this complex facial region. 
Best,
Mats Hagstrom MD

Jared Blau, MD - Account Suspended · Answer

Thank you for the question. Your skin appears to have great elasticity, which means a "scarless" (transconjunctival) lower blepharoplasty is a great option here.

Am I a candidate for lower bleph w/ fat repositioning? I'm getting different opinions! (photos)

Answers (5)

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