Lower Blepharoplasty with Fat Repositioning-Is There a Risk of Hollowing over Time?

Each patient has to be evaluated as an individual. In the past, a number of patients looked to "hollow" a few years after blepharoplasty when excess fat was removed. Now for most patients, I take the bulging fat and tuck it into the hollow below called the tear trough. This reduces the chances of looking hollow down the road. Surgery takes a little longer and has longer healing time but the results are superior for properly selected patients.

Just get the fat removed.  I have done thousands of lower lid blepharoplasties.  I have NEVER had a patient complain that too much fat was removed or asked to have fat replaced.  Fat repositioning is a silly operation and has inconsistent results.  Have the fat removed that keep this simple.

The real question should be who is a candidate for repositioning this fat and why. The fat that is repositioned comes from inside the orbital bone cavity so visible hollowing from the outside is moot.

This repositioning can only be done effectively on patients who have lower eyelid bags because it is the fat in those bags that surgeon drapes over the bone rim and is sutured to the cheek fat. In my practice I have seen 3 types of patients: those who have no visible lower lid bag, those who have bags that move in and out as the eyeball moves around and those in whom the bag is always our regardless of gaze. I only do the repositioning procedure on the last of these 3 because in my experience if you do it in the first 2 groups the fat goes back where it came from and does not stay repositioning. In those patients I prefer to use fat grafts or fillers.

Any procedure can be performed too agressivel by a surgeon who is not careful, including this one.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Dear Msjaws

Thank you for your excellent question!  Volume loss around the eyes occurs with aging.  After any surgery- grafting, repositioning or simple bleph- you can experience contour change that may require a touch up.

With Warm Regards,

Trevor M Born MD

 However, that does not mean you will experience this.  The real question is what is right for your lower eyelids at this time.  Without photographs and ideally a personal examination, it is impossible to know if your issues should be addressed with lower eyelid surgery.  Sometimes the contours in the lower eyelid are not caused by herniated or pseudo herniated fat.  There is no substitute for expert assessment.  Consider reposting with a photograph.

The orbital fat that is mobilized and repositioned is fat that is pseudo-herniating - meaning, it is causing an irregular, biconcave contour to your lid cheek-junction.  It remains pedicled to its blood supply to ensure its viability in its newly transposed location.  This improves the contour and reverses the signs of aging, but as you continue to age and lose facial volume it is certainly possible to begin appearing "hollow".  

Hello 'Msjaws', thanks for your question. If the lower blepharoplasty was truly done with just fat repositioning without any fat excision, then there should not be any risk of lower eyelid hollowing over time. However, there is a risk that the delicate sutures holding the repositioned fat in place could tear, causing the fat to be retracted back into place, in which case the lower eyelid fullness and fat herniation effects will recur. Lower eyelid hollowing is more a consequence of overly-aggressive eyelid fat removal, which some doctors still do. I recommend seeking consultation with a board-certified plastic surgeon in order to maximize your aesthetic eyelid rejuvenation. Good luck!-Dr.92660

Fat repositioning can be performed for lower eyelid contour issues. Usually the fat does not atrophy.

 There are no long-term studies available since it's only been performed the last few years. It is still controversial  procedure, so just understand that some  physicians  perform repositioning and some do a conservative removal a lower lid fat.

Many years ago lower eyelid fat removal was commonly performed during lower blepharoplasty. We have learned over time that overly aggressive fat removal can result in a hollow appearance in many patients as they age. Today fat removal is performed judiciously as needed. Fat transfer has become the solution for some lower eyelid deformities but could potentially cause hollowing as well. Your risk for this problem can be discussed after consultation with a board certified plastic surgeon.