Would fat grafting or fat repositioning deliver better results in the long term? Hoping to address lower eyelids (photo)

The lower blepharoplasty releases the fat and allows it to fill out the hollow tear trough. You may also benefit from a mid-facelift, extended browlift or facelift and browlift. Your forehead could be shortened, lower your hairline and correct the forehead wrinkles.

Best Wishes,

Gary Horndeski, M.D.

I prefer to harvest fat from the outer thigh or hip, process it, and then inject it to the tear trough. If fat transposition is done, there is a higher chance of that transposed fat being lumpy, while processed and injected fat is almost like a thick liquid. It also has good staying power as well.

The upper & mid-cheeks appear to have age-related volume deficit and since these regions are a major support for the under-eyes, it is no surprise to see significant under-eye hollows and tear troughs. Fortunately, the use of a robust HA volumizing filler for cheek augmentation will not only contour a more ideal, youthful, heart-shaped face, but will like secondarily improve the under-eyes, as well, with immediate, on-the-spot results and no significant post-treatment downtime. So, perhaps before jumping into expensive surgeries with significant downtime, you may wish to consult an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

Different surgeons have different perspectives on this, but I would recommend lower lid blepharoplasty with fat grafting based off your pictures. It blends the lower lid and cheek to a more youthful contour and appearance for a number of reasons. I'd recommend finding a Facial Plastic Surgeon, Oculoplastic Surgeon, or Plastic Surgeon in your area who specializes in lower lid blepharoplasty and fat grafting to discuss your different options.

Often a combination of procedures is helpful for the area under the eyes. The orbital retaining ligament is strongly attached and forms a severe groove between the cheek and the lower eyelid when the cheek tissue droops. To soften this distinction, fat grafting can help, although likely the midface needs to be supported back to its original position. There are several different ways surgeons do this. Some extend their blepharoplasty, some do midface lifting and others accomplish midface lifting as part of a facelift they perform.
The lower eyelid is a separate issue. You may have bulging of the lower eye fat pads (a photo with the eyes looking upward or an in-person consultation would be able to evaluate this). Depending on your surgeon's technique these could be managed either with removal or repositioning during a blepharoplasty. Either technique can work well. Some surgeons feel the lift of the midface resolves the issue completely without the need for blepharoplasty.

Both procedures are technically difficult and have uncertainty. Fat transposition leaves the fat with an attached blood supply, and the uncertainty becomes the correct placement of the fat, which is limited because it has to stay connected to its blood supply. Grafting in this area is unpredictable because the area has virtually no host tissue to support the graft. It is not easy either way.
Best,
Mats Hagstrom, MD