Am I a good candidate for lower bleph without fat repositioning? (Photos)

Question

i want go get a lower bleph and have had a couple of consults but i have had conflicting advice (all transconjunctival). based on the photos, would you trim the fat or reposition it? do i have enough cheek support to stop the outer corners of my eyes drooping/retracting? what complications are likely on removal vs repositioning in my case based on my eye shape and face structure/cheek bones? thank you

Lexie Wang, MD · Answer

Usually, the difference between repositioning vs not is completely up to the surgeon's preference, aka what they prefer to do, and very little to do with your anatomy. That being said, I would recommend you do repositioning + fat grafting because it looks to me like you have quite a bit of hollowing and I'd want to have as much volume as possible to work with for you. If you are doing removal, you should definitely bring up whether you need fat grafting too.

Andrew Miller, MD · Answer

Based on your photos, you are a great candidate for lower lid transconjunctival blepharoplasty with fat transfer at the same time. I would not make an incision under the eyelid because of your negative vector. Fat repositioning can be good, but occasionally it can result in lumpy fat. Fat that is injected works very well and is pretty much always smooth. Be sure to see a facial expert for consultation.

C. Blake Perry, MD · Answer

In my practice, I routinely perform either fat transposition or fat grating with lower lid surgery. With time as you age, you will loose volume in the anterior medial cheek. During surgery, this is a great time to prevent that hollowness and add volume.

Yucel Sarialtin, MD · Answer

Hello,
Thank you for your question.
Based on your anatomy, fat repositioning is generally preferred if you have limited cheek support, as it helps prevent outer eye drooping and hollowing. If your midface volume is good, trimming fat can reduce puffiness but may increase the risk of lid retraction or hollowing. Repositioning tends to have fewer complications like eyelid drooping, while fat removal can cause volume loss. A personalized evaluation is essential to choose the safest option for your facial structure.

Michael P. Morrissette, DDS, FACS · Answer

A lower blepharoplasty will reduce the protrusion of fat, but the best results are achieved with fat transfer or free fat grafting. Both techniques provide a more convex and youthful contour to the lid-cheek junction.

Tanya T. Khan, MD · Answer

Hi, you will likely benefit most from a transconjunctival lower blepharoplasty with fat excision. Once the prolapsed fat is removed, your skin will contract inward to create a nice smooth contour and blended lid-cheek junction. Do not think you need fat repositioning. Please see an experienced oculoplastic surgeon for best results.

Am I a good candidate for lower bleph without fat repositioning? (Photos)

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