What is the Point of Fat Grafting After Lower Blepharoplasty, a Procedure That Aims at Removing Fat?

3 weeks ago, I underwent a lower blepharoplasty to correct subtle eye bags. This was done in combination with a sliding genioplasty and aubmental lposuction to correct a receded chin. Since then, I developed dark hollow circles underneath the eyes. The surgeon I saw was in Spain, and I am now back in London. A PS I saw yesterday suggested fat grafting underneath the eyes to correct dark circles. But what's the point of removing fat during lower blepharoplasty then regrafting it?

Doctor Answers 9

Fat grafting after a blepharoplasty

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At three weeks after surgery, i would avoid any additional procedures on the eyes for at least six months. Give it time to heal.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Fat Grafting to correct aggressive blepharoplasty

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am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients.
Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.
Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Grafting can be the key to lower lid rejuvenation

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Current trends in lower lid rejuvenation are moving away from excessive fat removal and more toward fat preservation and repair of the supporting structure.  The aging process in the lower lid involves considerable loss of subcutaneous fat which creates and accentuates lower lid hollows, called the tear trough.  We often combining fat replacement in older individuals and in middle-aged. Sometimes fat grafting alone can correct and rejuvenate a lower lid.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Fat grafting post bleph

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There may be several reasons for dark circles under the eyes, including blue from veins, brown from pigment, and dark from shadows cast from overhead lighting.  There may be other reasons as well.

Based on your history, I am inferring that the second surgeon's opinion is that there is a hollowness in your orbital region, likely due to removal of fat during the initial operation.  So in this case it is to plump up the lid and reduce the hollowness of the lower lid area.


Management of Fat in Lower Eyelid Surgery

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What to do with the fat in the under eye area during a lower eyelid lift has been the subject of significant debate for years.  In my practice, I use some of the fat from the lower eyelid bags to fill in the hollow area between the eyelid and cheek.  In cases where too much fat has been removed (typically with a transconjunctival approach), structural fat grafting can be used to replace the previously removed fat.  Unfortunately, removing too much fat can leave dark circles or a hollow look -- even if the skin is smooth, this may not be desirable.

Lower lid blepharoplasty and fat grafting

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As we age, the fat pads around our eyes grow with time and become more prominent. These fat pads can be seen as "bags" under our eyes.  They are often surgically removed in a typical lower lid blepharoplasty. However, a lower lid blepharoplasty does not always address the tear trough hollows we have-- which is a result of subcutaneous volume loss.  The tear trough hollows can often be seen as "dark circles" or "hollowing" to the lower lid-cheek junction. Usually, we see both enlarged fat pads and a tear trough hollow in most people through the aging process.  But removing the fat pads through a blepharoplasty usually does not address the tear trough hollows alone.  So surgeons either reposition the fat pads rather than completely removing them to fill in the tear trough hollows or use filler material to fill in the hollows (such as hyaluronic acid or fat grafting).  Hope this helps.

Fat grafting

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I will often fat graft in the hollow below the eyelid (tear traugh) in combination with removal of fat from the lower eyelid bags.  They are two different problems and are addressed with different procedures.  However, if you are only 3 weeks out from your blepharoplasty, you may want to wait until all the swelling and bruising have resolved before deciding on fat injection.

Guy Cappuccino, MD
Mount Airy Plastic Surgeon
5.0 out of 5 stars 105 reviews

Fat Grafting to the Tear Trough after Lower Eyelid Surgery

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    The lower eyelid surgery removes fat from the eyelid and can be done when there is a noticeable amount of fat or herniated fat in the eyelid.   Some transpose this fat into the tear trough (inferior to the eyelid area).  Some fat graft the area.  Some patients require a combination of maneuvers to achieve the results they seek, depending upon preoperative anatomy.

Fat Grafting Beneath the Eyes: Benefits and Considerations

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Some patients have a combination of puffiness of the eye bags and hollowness beneath the eye bags, in the location where the eyelid meets the cheek.  I would predict that this was your case.  Once the eye bags were reduced, the hollowness which you did not really notice before has become more obvious.  A good temporary solution is to inject some Restylane into the hollow area.  When done skillfully, this should give a nice improvement with fullness and a smooth look.  It should last 6 to 9 months or more.  If you like the effect, then permanent correction with fat may be a good option.  Best wishes!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

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