What’s the Difference Between Hamra’s “arcus Marginalis Release” and Raul Loeb’s Technique?

Loeb has been in 1981 the first surgeon to describe fat repositioning in bleph.with his paper “fat pad sliding and fat grafting for leveling lid depressions.Clin Plast Surg 8(4):757-776”,then in 1995 Hamra published “Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Rec.Surg.96(2):354-362”.What's the difference (is there?) and which approach is more effective for bags and tear troughs? A surgeon i saw suggested transconjunctival fat rep.with the Loeb technique.

Doctor Answers 5

Difference between eyelid surgery techniques

 The difference between the eyelid surgery techniques  that you are describing are very technical and beyond  what most people  are able to understand the concept. It's best to look at finding a surgeon you can trust, has excellent results, has great reviews and an  excellent photo gallery that can show the surgeon's work. Also  important you have good rapport with that surgeon

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

What’s the Difference

For each result we try and achieve, many techniques are usually available. It is not the technique that gets the results, it is the skill and artistic insight of the surgeon. By our standards, those are now considered 'ancient' techniques. That does not mean they aren't good. Patients frequently come in with such questions gleaned from hours spent on the compujter without the 15-20 years of experience required to properly analyse the info. Pick the right doctor. His job is to worry about how to accomplish the result you are after.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Repositioning Fat in Lower Blepharoplasty


There is very little difference between any of the fat preserving methods or who first developed it. Sometimes a good method is developed simultaneously if everyone has been struggling with how to achieve a certain improvement. But frequently a technique is developed by one surgeon adding to a change made by another surgeon. If you went to either of the surgeons you mentioned and asked what technique was used now you would find the technique is quite different than described. This is because techniques are constantly undergoing tweaks to improve the results. However, there are some changes that stand the test of time. One of those has been the preservation of the fat to disguise the orbital rim and prevent skeletonization of the orbit. That basic technique is what then undergoes tweaks until someone discovers another modification that markedly improves the results, just as Loeb's and Hamra's improvement did. In the end, it really does not matter exactly what one calls the procedure, just that the major premise of the procedure (fat preservation) is being followed. Look instead for someone preserving the fat with significant experience and good pre and post op pictures that show the type of results you desire.


Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Fat repositioning with lower eye lid surgery.

They are essentially for all practical purposes the same concept. A trans conjunctival technique was published last year by Hidaldo and works well. However, even with the TC technique the lower lid can retract after surgery due to intrinsic scarring if there is any injury to the retractor muscles. However, this is rare with the TC technique and less common than with the anterior skin muscle flap approach, although in different surgeons hands they both work well. I would not spend so much time researching techniques as it is not the technique which is more responsible for your outcome, it is the surgeon. In fact, it is a good sign that this surgeon you saw wants to preserve your lower lid fat, so he is on the right track. Choose your surgeon based on experience, training, and proven results, not the particular technique or even worse, the price. Best of luck to you. 

Grady B. Core, MD
Birmingham Plastic Surgeon
4.6 out of 5 stars 12 reviews

What’s the Difference Between Hamra’s “arcus Marginalis Release” and Raul Loeb’s Technique?

      From a patient's perspective, it may be tempting to try to pin down the best technique for a given anatomy.  Verbalizing a technique means very little when it comes to executing a technique.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.