Can lower eyelid skin "tighten up" after lower blepharoplasty with fat repositioning?

With all due respect to plastic surgeons colleagues who have responded, your concern is well founded and has nothing to do with the skill of the surgeon. Although fat repositioning lower blepharoplasty has been my "gold standard" lower blepharoplasty for the past decade or more, in older patients that have started to experience skin laxity and wrinkling, repositioning the fat will "deflate the balloon" to some degree and lead to more wrinkle visibility. The skin will not "tighten" over time as there is no stimulus to create more collagen or elastin without a resurfacing procedure. This is usually not a problem for most patients younger than 45 years old, as there is still good skin tone, unless there has been extensive sun damage or smoking damage in young adulthood.
For patients 50 and older, I most commonly recommend a skin resurfacing procedure such as chemical peel or laser resurfacing to address exactly this problem. A skin pinch is an alternative for patients who are concerned with prolonged recovery after a resurfacing procedure which can leave your skin pink/inflamed for a few days to a few months depending on intensity of the resurfacing procedure. A skin-muscle flap with extensive re-draping and excision of skin is reserved for patients with significant excess skin, which is usually older patients with more extensive aging changes.

Having said all that, many patients do not mind a little additional wrinkling, but rather want to address the bags that make them look tired. I have posted a patient from my website who is 46 years old. You can see that after the fat repositioning, his skin does exhibit more wrinkling than prior to surgery, but he is still a very happy and satisfied patient. If your surgeon is experienced in the subtleties of eyelid surgery, as most Oculofacial Plastic Surgeons are, these possible eventualities, and options to address them, should be discussed in the consultation procedures.

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Hello! Thank you for your question.Without photos It is difficult to make proper evaluation. If you can provide photos from front of your face, from the side of your face and 1 meter away I would be able to make a proper evaluation. Anyway, sometimes after the surgery extra skin may be occur and you need revision surgery. For more fresh and younger under eye area I recommend revision eyelid blepharoplasty and fat injection to under eye area. However, with face-to-face consultation a healthy decision can be make. Best Regards!

After a lower blepharoplasty where fat repositioning was performed, it is possible for the skin to tighten up or retract over time. This is because the surgery involves repositioning or removing fat pockets that can contribute to under-eye bags and puffiness. However, it's important to note that every patient is different, and the extent of skin tightening or retraction can vary based on factors such as age, skin elasticity, and overall health.
In some cases, patients may notice that the skin around their eyes appears slightly looser after surgery, particularly in the initial healing period. This is normal and typically resolves as the tissues heal and the skin adjusts to its new position. However, in rare cases, the skin may not retract as fully as desired, leading to a slightly saggy appearance.
While this may be a concern, it's important to keep in mind that the primary goal of lower blepharoplasty is to address under-eye bags and puffiness, not to eliminate wrinkles or fine lines. While sagging skin can contribute to the appearance of wrinkles, it is not necessarily the sole cause. There are many factors that can contribute to the formation of wrinkles, including genetics, sun exposure, and lifestyle habits.
If you are concerned about the appearance of your under-eye area after a lower blepharoplasty, it's best to consult with your surgeon to discuss your options. In some cases, additional procedures such as skin resurfacing or fillers may be recommended to help address any remaining wrinkles or fine lines. Your surgeon can provide you with a personalized treatment plan that takes into account your unique needs and goals.

In the hands of a skilled surgeon, this is absolutely not supposed to occur.

Blepharoplasty can be divided into 3 categories : The conventional approach for addressing excess skin and fat under the eyes due to aging is through traditional lower blepharoplasty. This involves making an incision along the lower lash line and, if necessary, behind the lower eyelid to remove excess fat. In some cases, this fat can be repositioned to create a smooth transition between the lower eyelid and upper cheek. About 30% of patients require fat reduction. The incisions heal invisibly, and the procedure is effective for most patients.

For patients with only excess skin, a lower lid pinch blepharoplasty is a more suitable option. This procedure involves removing excess skin through an incision along the lower lash line, requiring only one stitch for quick healing.

On the other hand, younger patients with congenital puffy under-eye bags and thicker skin may benefit from a transconjunctival blepharoplasty. This approach involves removing under-eye fat pockets through an incision inside the lower eyelid, without removing any skin.