Lower Eye Fat Removal and Fat Graft (Re-Draping)? (photo)

Hello. I saw a PS about eye bags. He recommended a transconjunctival bleph with fat graft or "redraping" as he often said. He said he would cut a ligament and graft some of the fat down into the eye trough area to a bone somewhere around there. He said just removing some fat would not completely help the eye trough. Can you look at my pics and give your opinion as well? And if you agree, how good have your results been with that procedure? I want to do it but this is my first time.

Doctor Answers 7

Transconjunctival Lower Blepharoplasty

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There are many different approaches to performing lower lid surgery.  A simple transconjunctival removal of the herniated fat pads will give patients a better lid/cheek junction and you may not need any fat graft in that area

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Lower eyelid fat redraping

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There is no one way to do lower eyelid surgery.  Certainly the option that you have described is a reasonable one.  Another possibility is to remove the fat in a judicious manner and perform a micro fat transfer to the hollow beneath the eyelid.  Both procedures work quite well if they are done by someone with a high level of skill and knowledge

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Reasonable approach

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From what you have described, its hard to know which technique your doctor is advocating. One way is to do a transconjunctival approach, but instead of removing the fat, repositioning it into the tear trough.

The other technique is to remove the fat, and then harvest fat from elsewhere and inject it deep to the muscle in the tear trough region.

Both techniques have merit, and as long as the surgeon is experienced and comfortable with the technique, you should have nice results.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Second opinion on fat graft and transconjunctival blepharoplasty

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Different surgeon have different approaches depending on their experience with various procedures. I would recommend a transconjunctival lower lid blepharoplasty to remove the bulging fat. Once you have healed from surgery, if you are still bothered by the depth of the tear trough hollows, I would inject a filler such as Restylane to fill in the tear trough area. While this approach may be more conservative, it comes with lower risk, less recovery and has a more predictable outcome.

Anita Mandal, MD
Palm Beach Facial Plastic Surgeon

Blepharoplasty# #cosmeticsurgery

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Dear Sunset2Sunrise


Thank ypu for your question and photos.


The procedure you are describing is excellent.  I perform a similar surgery for patients like you and have had tremendous success over the years.


Good luck!

With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Transconjuctival Blepharoplasty Treatment of Lower Lid Bags with Hollowing

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Transconjuctival Blepharoplasty Treatment of Lower Lid Bags with Hollowing in Younger Individuals

Without an exam or detailed photos other than the single one you provided specific advice cannot be given. However from your description, photos, and young age, I would recommend repositioning your  fat pads from an invisible incision just inside your lower eyelid (transconjunctival approach). I think that this is what was recommended to you  - but it is repositioning rather than "a fat graft". By repositioning, a thin membrane called the arcus marginalis is released,  the fat is allowed to slide down filling in your hollowed area.  By using your own fat can remove or reposition your fat pads a fat transfer is usually not required.

Get a second opinion, and look at the doctors' work

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Thank you for your question.  You are asking for other opinions other than that of your current doctor, and this can generate a lot of different answers and even conflicting opinions.  As a specialist in cosmetic procedures in the eyes and face, I can say that what your doctor recommends is certainly reasonable for people who want to address their large under eye bags.

Something I want you and others to know who are considering a cosmetic procedure is this - cosmetic surgery is very much an art.  I have trained many doctors in surgical techniques, but even after showing them how to do something, they will do it their own way.  This does not make them right or wrong, but it must be understood that there is a lot of variability in doctors' surgical techniques, and the terms they use to describe them.  For the patient, terms and techniques are not as important as the results, how the techniques are executed, and when they're executed.

When choosing a cosmetic surgeon, you must make sure you are comfortable with your decision.  Analyzing a surgeon's work through their before and after pictures of their patients will help with your choice.  Getting an additional opinion by seeing more than one doctor is also important.  When seeking more than one opinion, you may get agreement with specific procedures, or some saying it only works part of the time, or having recommendations conflict with each other.  The important things are that you are comfortable with doctor, their work, and the procedures that you will undergo.

Even with the best surgical hands performing surgery, there can be some potential, unforeseen issues.  While poor surgical technique is possible and can be avoided, issues are more likely from a combination of circumstances and healing.  So based on this I'd like you to get another opinion and be confident with your choice.  Thank you for your question, and I hope that this is helpful.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 79 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.