Which Procedure is Right? (Photo)

Torn between 2 drs. for l/bleph. Both excellent. Both would reduced fat and release arcus. Doctor #1 would reposition some of the remaining fat, says I do not have true excess skin but would do a TCA peel, can always do skin later. Doctor #2 would add fat back via grafting, it gives him more freedom, says I DO have excess skin. I trust both doctors. Based on the photos of my anatomy does one method seem advantageous? Is either method safer or more proven for long lasting results? Many Thanks.

Doctor Answers 5

Get a third opinion

Your skin is too thin for fat grafting and it looks like you have enough fat just to have some removed, repositioning it is good sometimes, but it looks like that might not be the best thing for you. I still like removing some fat through a trans conjuctival incision and then sometimes taking a pinch of skin or using a TCA peel for the crinkly skin.

New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Lower eyelid blepharoplasty

When herniated fat pads are present, we perform a conservative fat removal through trans-conjunctival approach on the inside of the eyelids. If excess skin is present at rest( not animation), then we perform a pinch technique of the lower lid skin and close that incision with tissue glue. For many examples, please see link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Which Procedure is Right?

Again NOTHING replace IN PERSON examination! My guess would be a transconjunctival bleph with a combination fat grafting and either TCA or modified phenol peel.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

From your photos, you would do well with the fat repositioning.

It does not look like you have so much fat that any should be taken out.  I would try to place it all into the tear trough.  And if this is done, you shouldn't need a fat transfer. Once the fat is repositioned, you may have some extra skin which could be removed with a pinch.  Or you could do the TCA peel which will give you some tightening.  If you still have extra skin, you can remove that easily in the future.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

I agree with doctor #1.

The problem with fat grafting is that your eyelid is so thin, there is a very high probability that you will have lower eyelid lumps and bumps from grafted fat.  A TCA 35% peel is a modest peel.  Less is more.  This suggests that the first surgeon has good operative procedural judgement.  Using grafted fat in a lid like yours suggests less than ideal procedural judgement in my opinion.

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