What are the pros and cons between Fat graph vs blepharoplasty? (photos)

You appear to have some prominent eyes and some eyelid retraction.  Have you been evaluated for thyroid disease?  Make sure you do that before and surgical intervention.  In your lower lids you do have some hollowing.  Doing a routine bleph could worsen this.  A fat transfer may help.  Often its good to try some filler first as this will give you an idea of the results you can obtain with adding volume to the area.  Fat can be tricky here so make sure you go to someone with a lot of experience with fat in the lower lid. When done correctly it should last for a long time.     

Based on the single
photo you’ve submitted, I observed that you have relatively prominent eyes,
puffiness and hollowness below the eyes. The key to coming up with the best
plan for you is by identifying what affects your appearance the most. It is
always tempting to have multiple procedures at one time, but I strongly believe
in minimal trauma and trying to get the goals clearly defined. Different
doctors will have different perceptions about a patient’s case. I had a number
of patients who come into my practice and had procedures done by another
doctor. They were disappointed with their result because their expectations
were not met.



Fat grafting placed
in the lower eyelid area is unpredictable. Although theoretically or
technically it makes sense to try to restore fat in the lower eyelid area, but little
bumps and irregularities are often seen in fat grafting. About 30-70% of that
fat can get absorbed. In addition, the lower eyelid skin is so thin that it
easily shows all irregularities. I have had patients who came from all over the
world that had fat grafting and they wanted me to remove the lumps. I have to
get the grafts through different planes of the eyelid in order to reduce the
irregularities and very often it results in potential destabilization of the
eyelid structure and requires more than one surgery. Fat grafting placed in the
cheek area, nasolabial folds and in other areas except the lower eyelid is
acceptable as those areas have thicker skin so it will not show irregularities.




If we are dealing
with a face that is relatively hollow like yours, I suggest a facelift, volume
augmentation in the cheek area or placement of submalar or cheek implants.
Also, there are certainly many options to explore when dealing with the lower
eyelid puffiness. A limited blepharoplasty such as a transconjunctival
blepharoplasty with some reduction of that fat may be helpful for you.



If you are going to
choose fat grafting, have it done in the face rather than the lower eyelid. There
are also alternatives to fat grafting on the face such as the placement of
submalar implants to add volume in this area. Think about your priorities, find
a doctor that you resonate with and take smaller steps. Be more conservative in
the beginning before you move forward with a more extensive type of procedure. I
hope that was helpful, I wish you the best of luck, and thank you for your question.



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