Why are some surgeons still against fat-pad repositioning as part of lower blepharoplasty?

Sometimes, all it takes is one patient with a bad outcome to “scare” a surgeon away from trying certain techniques. There is no body of evidence for MOST things in plastic surgery because studies are not well funded for cosmetic medicine, study sizes are small since they are often single surgeon, and results are often subjective.

My advice is to either decide you appreciate this surgeon’s aesthetic (based on before and after photos) or find another surgeon. ENT and plastic surgeons can be just as qualified as oculoplastics to perform these procedures.

It is always individual decision. Most surgeons using transconjuctival approach will combine resection of the excessive fat pads and transposition of the small flaps over the orbital rim to provide some augmentation of cheek/lid junction. We use fat grafts for patient who need it rather than HA filler. Combination of specific procedures is individual choice which depends of the patients needs but also, surgeon’s preferences. Hope this helps.