Lower Eyes: Should I Get Fat Removed?

some doctors say it is not wise to remove the fat pads unfer the eyes as it will give a person a hollow look.rather pull the excess skin and go with cheek implants. others support it and say it is better to remove it. how does a patient know which way to go?

Doctor Answers 16

Many different techniques

THere are many different techniques to "skin a cat" so to speak. It depends on the doctors training and experience, as well as the patients anatomy on which technique to use. Without seeing your photos, its hard to give a judgement.

In general, be wary of any surgeon that says "I'm the best" or "this is the only right way to do it". Make sure you get a second opinion.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Fat pad removal of the lower eyes

A photo of your eyes would be very helpful in tailoring the answer to your specific anatomy.  That said, in general, maintaining as much volume in the face as possible helps to maintain a youthful appearance.  Resection of too much fat can leave a hollowed appearance and a premature aged look.  But some patients have very large lower eyelid bags and a sculpting of that fat can rejuvenate the lid.  As indicated in the other expert answers, there are a number of ways to treat the fat and it must be tailored to the patients anatomy/defect.  Find a board certified plastic surgeon and ask to review results from their eyelid cases.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 98 reviews

Lower Eyelid Lift Fat Removal

It is hard to give you a simple answer with regard to lower eyelid fat removal in your case.   I have many ways of sculpting the lower eyelids in order to best suit the patient and achieve the best results given their particular anatomy.   Sometimes fat removal blepharoplasty is necessary. In other patients I will not remove the lower eyelid fat but reposition the fat to fill in depressions below the lower eyelid.  Microfat transfer is sometimes combined with a lower lid lift to optimize the surgical results.   Finally midfacelifting can sometimes help the lower eyelid appearance more than a lower blepharoplasty alone.   A cheek implant should will generally not help the lower eyelid appearance.   Pictures would help to give you a better direction as to which of these combinations might be best suited to you.  I would suggest someone experienced in some or all of these techniques. 

James C. Marotta, MD
Long Island Facial Plastic Surgeon
4.8 out of 5 stars 71 reviews

Conservative Lower Eyelid Fat Removal

The key to lower eyelid fat management is conservative removal. Some patients simply need to have some of the herniated fat removed to get a good result. In some patiengts it may also be beneficial to not remove it but redistribute over the lower orbital rim to improve tear trough problems. While cheek implants have a role in midface rejuvenation, there are not a substitute for lower eyelid fat removal or provide any aesthetic help in that regard.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Lower eyelid fat removal during surgery

Without a photo it's really hard to give you good advice.  However, I do more eyelid surgery than anything else and it is common for me to take fat or at the very least reduce it with a little cautery.  It's wise to be concervative with fat removal to avoid hollowness of the lower eyelids but it's very uncommon.  Frankly, many surgeons don't want to go the the effort to remove it because it requires more expertise and more time.  FYI, fat removal can add some swelling and bruising to your recover but it's often well worth it.  Best of luck,  Chase Lay, MD


Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Removing fat

The answer is that there is no way for you to know. As there are differences among the surgeons. It is more important to look at actual results from the doctor you are considering and follow his/her advice.

Michael Hueneke, MD
Nashville Plastic Surgeon
4.9 out of 5 stars 63 reviews

Lower Eyelids-Fat Removal or Something Else?

The most important thing you can do is have a consultation with an experienced plastic surgeon who can analyze your particular problem.  There is rarely a situation where a "one-size fits all approach" is applicable.  A judicious removal of some fat and skin can provide excellent results in properly selected patients.  Other patients may require alternative approaches as you have suggested.

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 18 reviews

Lower Eyes: Should I Get Fat Removed?

  Lower eylid surgery is performed properly when the appropriate amount of excess fat is removed....doing so would not create a hollow which occurs from removing too much fat.  Cheek Implants shape the cheeks and can often highlight, not conceal, existing lower lid hollowness IMHO.  

 How do you know who's opinion is correct?  Simple, be sure that the MD that does the fillers or the plastic and cosmetic surgeon you select for Eyelid Surgery or Cheek Augmentation using implants understanfds and follows the proper aesthetics of facial beauty.  The proper aesthetics of facial beauty allow the creation of a naturally, youthful and attractive face.  IMHO, without that...it's hit or miss.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Treatment of tear troughs and lower eyelid bags

Not all fat pads in the lower eyelids are alike so the treatment cannot be cookbook see this do that. A deeper analysis of the situation is required. Are the pads only present on extreme gaze such as looking upward or do they completely disappear when looking downward? Is there excess skin present in addition to the bulging fat? In some patients it is better to remove the fat, in some patients it is better to place a filler (fat or injectable) into the lower eyelid crease, in some it is better to suture the bulging fat to the deep cheek fat with or without some trimming etc. Without a face to face examination it is impossible to know what would be best for you. Even photos are insufficient as they do not show how the eyelid and eyelid fat change with motion.

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Fat Pad Removal Under Eyes

I believe that the reduction of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads  can result in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.
Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 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.