Lower blepharoplasty hollow face (Photo)

Question

I am decided on a deep plane facelift with fat transfer but confused about my under eyes. Mixed views - some say blepharoplasty with fat grafting. Others say lift the SMAS over the junction with fat transfer. I have significant loss of volume and want to avoid more hollowness.

Basil Pakeman, MD · Answer

I can certainly understand your dilemma, whether a facelift (smas lift or deep plain lift ) with fat grafting or a blepharoplasty is an option to help improve the hollowness and volume loss of your lower eyelids. All these choices are all viable options that would improve the appearance of the lower eyelid. The question becomes how I get the best result with the least amount of surgery. 
Your choice of a deep plain facelift with fat transfer Is a good and reasonable choice. This will help to improve the eyelid appearance and possibly avoid a blepharoplasty If not needed. This will allow to see the result without a blepharoplasty, and if you’re happy with the results, End of story! If you feel that you need further improvement, then a blepharoplasty can be done later. They also the possibility you can do all three at the same time. Your approach is logical and reasonable.

Jill Hessler, MD · Answer

The facelift can address the sagging and laxity of the face quite nicely. It may restore some mild volume to the eye area with a deep plane approach to the facelift, but facelifts will not address eye bags or significant hollowing immediately around the eye area. To specifically target the lower eye area a lower eyelid blepharoplasty with fat transfer is generally recommended. I recommend patient's seek consultation with a surgeon that frequently performs all rejuvenation procedures of the face and this surgeon and instruct you on the procedures for the most harmonious result.

Mats Hagstrom, MD (license on probation) · Answer

A facelift treats, the lower 1/3 of the face and neck.
It has really little to no impact on the midface and lower eyelids.
When doing a facial assessment, plastic surgeons often divide the face into thirds.
The lower third the soft tissues around the mandible.
The mid third are the tissues around the maxilla, including the orbits.
The upper third is the forehead and hairline.
Facial volume restoration can be achieved in a number of ways.
Fat transfer is one of them. Facial fat grafting can be unpredictable, imprecise, and potentially unforgiving if patients don’t like the outcome.
The gold standard in my opinion is working with fillers, but I do think grafting fat in conjunction with a facelift is an excellent idea and I think most plastic surgeons use grafting in conjunction with facelift. 
It’s not wrong to reassess midface volume at a later date after your primary procedure and consider some touchup work. 
I generally stair towards a more conservative approach or reluctance when it comes to removing tissue in a permanent and irreversible manner. This is especially the case around the eyes. 
The problem with having facial fat transfer in conjunction with a facelift is that it becomes very difficult to differentiate if the fat transfer was successful or not, because the facelift will have a significant amount of impact.
This is often the case when patients have multiple procedures in the same general area.
If you’ve selected a provider, then I suggest you go with their recommendations.
If you haven’t selected a provider, then I suggest you focus on that before coming up with a surgical plan.
Patients are usually not in a good position to formulate their own surgical plan and I think it’s better for patient to focus on provider selection and then let the provider come up with a plan that will work for you.
In other words, let the driver do the driving.
The most important variable tends to be provider selection, and if that part is done correctly, then everything else tends to fall into place.
Let the doctors do the doctoring and focus on the role of the patient which, as I mentioned earlier should be selecting the best provider.
Granted, finding the best plastic surgeon is not at all easier straightforward.
During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics to your own.
They should be able to show you accurately what your results are likely to look like.
Providers who don’t have an impressive collection of before, and after pictures of previous patients with similar characteristics may not be the right provider.
Highly experienced plastic surgeons should have access 100 or preferably thousands of before, and after pictures to choose from.
Bring a pictures of your face, the same way plastic surgeons take before and after pictures and use those as reference during the consultation, especially when reviewing before and after pictures.
There’s no correct number of consultations needed to find the right provider.
The more consultations you schedule the more likely you are to find the better provider for your needs.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
The second biggest mistake I see patients make is relying on virtual consultations, which in my opinion is a big mistake.
I generally always recommend having in person consultations exclusively.
Patients often don’t use the right criteria for provider selection.
In the hands of the right provider, you should have a pretty good understanding of what you look like afterwards, and this should be conveyed by showing you more before and after pictures that you have time to look at.
Good luck with your upcoming procedure.
Best,
Mats Hagstrom MD

Lower blepharoplasty hollow face (Photo)

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