Bump from repositioning - is there risks to going back in and fixing it? (Photo)

Question

I had horrible fat repositioning on one side that causes a huge bump/lump/bag. It's not scarring confirmed by 3 occuloplasts. It's very soft and feels like fat. It moves when I speak and lift my eyes up and all around. Is there a way to go back in transconjunctival and fix this? Either debulk, reposition, or fully remove? Has anyone done this before? The main concern is scar tissue but i don't know if possible to fully dettach from my cheek

Thomas A. Mustoe, MD, FACS · Answer

You need to wait at least a full year from your initial surgery but through a transcontival approach it should be possible to remove the excess fat. Some fat grafting g might be necessary.  Repositioning fat has limited flexibility in terms of the position of the fat.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Jacob Tower, MD · Answer

Hello, hope you are well. I wouldn't recommend doing anything until the area has healed completely and you are certain that any residual edema has resolved. Having said that, let's assume your primary lower blepharoplasty was performed long ago. If it's malpositioned or excessive fat, I would be optimistic about a revision lower blepharoplasty to debulk it. However, rather than a transconjunctival approach, a more direct subciliary approach should be considered. The disadvantage is the skin incision, but the surgical access and visualization is superior for refinement like this.
Best,Dr. Tower

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

The most likely thing that has happened to you is that the fat which was repositioned to plump your dark circles has retracted back into the lower eyelid space.

When fat is repositioned the fat is left attached to its blood vessels to keep it perfused.  The problem is with eyelid motion this fat that his transplanted can be pulled back into position by the blood vessels and its attachments.

Correction of this problem require surgery to I the remove the fat or as I do in my practice place the fat as a composite graft no longer attached to its vessels and tissue.

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