Can lower eyelid fat repositioning damage the tear trough area?

Question

Hi, i am doing research into lower blepharoplasty. I was wondering nowadays when the ps remove the fat bags and leave a bit left and reposition it in the tear trough area, does that break the tear trough area? if so, then will that cause the droopiness of the cheeks in the long term? I just read someone's review stating that this happens when ps repositions that fat into the tear trough. Is this true? Thanks!

C. Blake Perry, MD · Answer

Fat repositioning is a common technique when performing lower lid blepharoplasty. This involves moving the fat from the lid into the tear trough and cheek to add volume to the midface. This does not damage the tear trough area. This technique does involve the release of ligaments around the tear trough (orbital retaining ligament/arcus marginalis) to allow the fat to sit in the correct position. However, this does not affect the cheek fat pads. The cheek fat pads will continue to descend with time and gravity. Best to see an eyelid expert in your area.

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.

Lexie Wang, MD · Answer

Hi Fabulous. I'm not sure what you mean by breaking the tear trough area. The idea of doing repositioning is that you disrupt the tear trough ligaments and then push fat into the hollowing at the tear trough so that overall you have a smoother contour from lid to cheek. This should not cause any droopiness of the cheeks (if anything, it should add volume to the cheeks). Good luck!

Kenneth D. Steinsapir, MD · Answer

That does not mean that all surgeries do smoothly. If lower eyelid fat is not preserved with the transposition of fat into the top of the cheek, the under eyes can look a bit hollow. That is why this fat is now commonly preserved and transferred into the under eye circle at the top of the cheek. The surgery does not cause droopiness of the cheek long term.

Suleyman Tas, MD, FEBOPRAS · Answer

When performed correctly, repositioning fat during lower blepharoplasty shouldn't break the tear trough area or cause long-term cheek droopiness. Individual outcomes can vary, so consult with an experienced surgeon for personalized advice.

Lisa Brostrom, MD · Answer

Hello and thank you for your question. Lower eyelid fat can be addressed in a number of ways. Fat can be transposed across the orbital rim to prevent hollowing in the tear trough and to replace volume deficiency along the orbital rim. However, I have found this technique provides inadequate volume. I prefer to remove the herniated fat bags and address the volume deficiency along the tear trough and orbital rim with microfat grafting to smooth the lid cheek interface. This provides more fat which can be evenly distributed over the tear trough, orbital rim and upper cheek, and the microfat blends the lid-cheek junction more effectively in my experience.See a Board Certified Plastic Surgeon who can help you achieve your goals. Good Luck! Dr. B

William Portuese, MD · Answer

In our practice, we only do fat repositioning for upper eyelid surgery when needed. We perform a transconjunctival conservative fat removal through the  inside of the lower lids to rejuvenate them.

Can lower eyelid fat repositioning damage the tear trough area?

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