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.