Fat Removal or Fat Repositioning: which is better for my situation? (Photo)

Hello, thank you for your question and the photos. Based on the photos you provided it appears that you have some mild upper eyelid skin redundancy as well as lower eyelid fat pad herniation. A combination upper and lower blepharoplasty would help correct all of those issues. In terms of whether lower fat pad repositioning or excision would be best is up to your plastic surgeon. I typically perform fat pad repositioning and minor excision only in cases where there is significant fat redundancy that would leave a contour abnormality. This decision is made intraop during your procedure. Removing too much of the fat pad can lead to under eye hollowing, as you remarked. I would advise finding a surgeon that performs a technique similar to what I described above. Best regards.
Adam Bauermeister, MD

Hi @zoreo! Thank you for sending your photos-- you would be a great candidate for a transconjunctival lower blepharoplasty with fat repositioning. A lower blepharoplasty will address the herniated fat pads and excess skin under your eyes giving you a more refreshed and rested appearance. Best of luck, Dr. Nima!

Hello! First of all thank you for your question.I have evaluated your case regarding the information you provided and your photos.Your eyes are big. Your mid-face area and malar bones don't support your lower eyelid area which gives you hollow appearance and fat protrusion in upright look and smiling.You have lateral rounding in your lower eyelids and most probably from the profile view, you have a negative vector which malar bone is behind the cornea level. Your lateral brows are down as well. Your mid-face should be supported with endoscopic mid-face and brow-lift.In addition, I recommend fat transfer to lower eyelid and mid-face to make your looking better.

Common reasons for lower blepharoplasty include tear trough deformity or pseudoherniation of the orbital fat. An in-person exam would provide a more accurate diagnosis, but preliminarily based on your photos it does appear you have pseudoherniation of fat creating "eye bags.” They should also be more prominent when you look up. Transconjunctival lower blepharoplasty with fat repositioning will provide nice results and a better lid-cheek transition in this case. @drdonyoo

Based on your photos, you are a great candidate for lower eyelid surgery. The fat be removed or repositioned. With fat repositioning, there is always a chance that the fat can get a little lumpy. We like to remove the fat, and then harvest some fat, process it, and reinject into the crease below your fatty bag and your flattened cheek bone in that area. You need something there, so I wouldn't just remove the fat and do nothing else. Be sure to see facial specialist for consultation.

In your case, dominant feature is tear trough deformity, created by muscle and ligament insertion underneath the eyelid. There is also small fat bulging. This is all due to malar hypoplasia (small cheek bones). Correction should involve release of the muscle and ligamanet insertion as well as placement of fat pads underneath muscle to prevent recurrent adhesions and fill the space. However, problem of small cheek bones remains. Placement of small cheek implants would be the way to correct it; it can be done in the same time as lower blepharoplasty. Hope this helps.

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Under eye bag removal can be done on those who look tired and older due to excessive development of fat under the eyes. It occurs as the membrane surrounding the fat under the eyes weaken and lose elasticity. Since the operation is performed under the inner conjunctiva of the eye,there is no occurrence of scaring. Make an incision along the inner conjunctiva and remove excessive sagging fat then reposition the remaining fat and smoothen the area. It can prevent the re-occurrence of under eye fat so no worries!

Thank you for your photos. I agree with your surgeon. It would be a good idea to reposition the fat that is under your eye and giving you bags and use it to improve the more hollow area where your eyelid transitions to the cheek. That means no fat is actually removed, it is simply moved over to where you need it. The fat will not move on its own back under your eye with time. Once it has been placed elsewhere, it stays in that area. Hope this helps!!

Johnson C. Lee, MD
Double Board-Certified Plastic Surgeon

At age 25, your skin tone in your lower lids is just fine. No skin removal/ laser treatments are required. A trans-conjunctival approach lower blepharoplasty with conservative fat removal it's all we would do in our practice. Two very small incisions are placed completely on the inside of the lower lid where the fat bags are removed. This is done under a brief general anesthesia as an outpatient procedure. We've seen too many complications from fat repositioning, and that procedure doesn't work very well.