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

In a lower blepharoplasty with fat repositioning, is there a chance that the area where the fat was removed from will become "hollow" over time? Even if no fat is removed, just re-positioned, is it possible that it could be too aggressively transferred from it's original site? Im curious to know if there are any long term studies on this.

Doctor Answers 12

Eye Hollowing After Fat Grafting or Repositioning Unusual

Thank you for your question. There is always the possibility of loss of fat and hollowing after fat grafting or fat repositioning but it is rare.

I have used fat grafting to plump the hollow eye and treat dark circles under the eyes for 10 years in hundreds of patients. In my experience hollowing or loss of fat is very rare. In fact today I use smaller grafts because the most common problem I have seen is that too much fat has survived in some patients.

See an expert who is experienced in this technique as very few are.

According to most experts, lower blepharoplasty with fat repositioning is best for most patients

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.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 126 reviews

Is there a risk of hollowing after fat repositioning? Absolutely!

 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.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews


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.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Long-term studies with fat repositioning of the eyelids

 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.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Hollow Appearance After Lower Blepharoplasty

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.

David S. Motoki, MD
Draper Plastic Surgeon
5.0 out of 5 stars 16 reviews

Eye #blepharoplasty #eyelid surgery eyelid injections

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

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 118 reviews

Risks for Blepharoplasty

Complications can and do occur for all surgical procedures . Complications are reduced in the hands  of well trained and experienced surgeons.

Jay M. Pensler, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 14 reviews

Lower blepharoplasty with fat repositioning

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".  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 58 reviews

Hollowing after fat grafting.

Hi Msjaws. Yes.  Plastic surgeons can "turn back the clock", but we cannot stop it. As time passes, there will be involution of facial fat whether or not you have an blepharoplasty.  Overaggressive fat transferral can lead to a donor-site deformity.  I suggest you see a plastic surgeon to discuss the features which concern you, and determine the best surgical plan for correction. Good luck.

Lewis Ladocsi, MD, FACS
Richmond Plastic Surgeon
4.8 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.