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

Blepharoplasty is a surgical procedure where the contour of the lower eyelid and sagging skin and muscle are correct through surgery.  This may involve removing or repositioning fat in the lower lid and resupporting the skin and muscle.Fat grafting is moving fat from one area of the body (usually the flanks) to the eyelids.  Both are complicated procedures and must be done by someone who has experience in both areas.  Sometimes they are used in combination to achieve the most youthful results.Dr Lattman

This is consistent with thyroid eye disease.  If one of these 15 surgeons in their rush to get you signed up for surgery have not noticed this before, I recommend seeing an oculoplastic surgeon to get an actual work up for your issue and once it is clear what is going on, then you and your surgeon can decide what is best.  Just looking at your photo, I would love to see picture of you from years ago to understand when this change in appearance occurred.  You might also benefit from a cosmetic orbital decompression.  I see several consults a week where patients have had unsatisfactory fat grafting to this lower eyelid.  I would recommend that you first get a work up and determine if you Thyroid eye disease.  The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a directory on their website (ASOPRS dot org) that can assist you to find a well qualified surgeon who processes the clinical skills to assess you and manage the condition.

Thank you for your question.  This is a complex topic to cover, but I'll do my best to hit some of the more important points to consider.Fat grafting takes fat cells usually from your abdomen or lateral thigh via a low negative pressure liposuction technique and then injects those cells into areas where there are concavities or shadows.  The fat maintains the properties of the site that it was harvested from.  It does not assume the properties of the area that it is injected into.  The is important because if you have weight fluctuations and you gain weight more in your lower half than your upper half, this can lead to lumpiness even years down the road.  The amount of fat that gets vascularized and lives after injection is technique dependent.  With modern techniques and equipment, skilled injectors have very little fat that does not "take".  Poor injectors have about a 50% resorption rate.  Fat transfer does not help rejuvenate the upper eyelids (unless you have hollowing).  The double convexity of the lower lid is in large part caused by fat herniation (pooching out) from under the globe (eyeball).  Thus, you actually have excess fat in this area.  Fillers or fat transfer camouflage this by diminishing the irregularity.  This is not addressing the underlying problem of the fat herniation.  Blepharoplasty actually addresses this problem (fat herniation).Blepharoplasty is used to address aging of the upper and lower lids by removal of excess skin and either removing or repositioning fat.  Surgery attempts to restore the youthful external appearance of the upper and lower lids.  It is less of a camouflage technique.  There are multiple blepharoplasty techniques, particularly in lower eyelid surgery.  Many factors need to be taken into account and a person's specific anatomy often dictates which technique is used.It is not unusual for someone to have both blepharoplasty as well as fat grafting (or fillers) to the tear trough as they can be complimentary.Both fat injection and blepharoplasty require significant talent.  I would recommend consulting with one or more well respected facial plastic or general plastic surgeons in your area who perform both so you can have a full exam and go over this complex topic in more detail and get a tailored approach to your eyes.  All the best!

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.     

It does seem that you have not been able to trust one of your doctor's opinions yet.  I understand that this may be difficult when it seems like the opinions you're getting conflict.  There is an art to blepharoplasty surgery as there are to many medical procedures, and thus each surgeon will have their own preferences and favorite approaches to the same solution.  For example, some surgeons will have more experience and talent with one technique "fat transfer" or "bleph." There are many correct answers to improving your under eye as I have seen in the answers you have received so far.  Part of undertaking a cosmetic surgery is having trust in your physician as well as believing in your readiness for the procedure.  Building trust for a physician is more likely to come after all your concerns have been fully addressed by that physician.  Maybe, you could have a second consult with one of those doctors you already saw to make sure all your concerns are fully addressed.  Personally, I prefer blepharoplasty with filler treatment, in that order, over fat transfer, but that is because my talents lie with those and another surgeon would probably be able to achieve the same beautiful result with fat transfer.

It does appear that you have a tear trough hollow this can be treated with fillers.   This can give you an idea if what fat grafting or tear trough silicone implants can look like.  The problem with fat gafts are that they can be lumpy and so cells die while others hypertrophy or get larger.  

Blepharoplasty is a complex surgical procedure that requires  a lot of knowledge of anatomy (soft tissue and bony anatomy), physiology and function of the eye, eyelid, and brow. The position of the eyebrow and the position of the lids is very important in deciding the type of surgery or procedure needed. The picture posted seem to show a very high position of the upper lid, maybe a low brow, receded infra-orbital rim. Thus a thorough evaluation is needed.

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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I strongly suggest a combination of both procedures. Through an incision on the posterior surface of the eyelid some excess fat can be removed while also repositioning some of the fat in the groves at the bony margin. With this technique survival of the fat is excellent; much better than harvesting the fat from another spot on the body.

Based on your picture alone, you seem to have a thyroid related eye deformity with bulging of the eye itself and eyelid retraction. I would strongly suggest against any sort of cosmetic eyelid procedure whatsoever-- it would be a huge mistake with an extremely high risk of postoperative complications. You do exhibit a tear trough deformity-- the deep groove about a centimeter or two below your lower eyelids than can be successfully camouflaged with injectable fillers or with fat grafting. Fillers offer more precision and are readily reversible if you do not like the result. The injections do however need to be repeated on a yearly basis. Fat grafting can also provide a nice result to this area, but the results are more unpredictable and often need additional touch up sessions to get a perfectly refined result. While the result is long lasting, increases in your overall weight as you age can have the adverse affect of this area becoming too full with expansion and growth of the transplanted fat to this area.