Transconjunctival Blepharoplasty with Fat Graft for Eye Hollows? (photo)

-Is there possibility of nerve damage? -Is a fat graft necessary for my hollows? Blepharoplasty already involves removing and repositioning existing fat? -How is the fat prepared and deposited into the eye area and is it permanent? I exercise a lot and am already thin so is it worthwhile for me? If the fat isn’t permanent how can I expect my eyes to look five years from now? -What types of lasers can be used, and which is best? -Are there other options besides blepharoplasty and fillers for eye bags?

Doctor Answers 8

Yes, there are many options.

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I personally do not think that fat grafting is so wonderful for this area.  Your skin looks loose and thin.  This makes you a poor candidate for under eye fillers.  An option that you have not mentioned is a phenol chemical peel of the lower eyelid area.  This is a great option and the healed skin pushes the lower eyelid fat back so that surgical options are not necessary for many cases.  Regarding lasers, there is no evidence that using a laser incisionally is actually better for outcome than any other incisional methods.  Don't get caught up in marketing hype.  For skin rejuvenation, chemical peels are better but you need to have a very experienced chemical peeler.  Lasers are increasingly disappointing because surgeons have gotten smarter and are doing far less skin injury with each treatment to avoid complications.  Nerve damage is definitely a possibility.  This can be either sensory-rare- or motor-much more common.  Motor nerve damage risk is minimized by avoiding lower eyelid surgery that involved cutting the skin.  Hope this information is helpful.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Transconjuctival Blepharoplasty Treatment of Lower Lid Bags with Hollowing in Young People

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Treatment of Lower Lid Bags with Hollowing in Young People
Without an exam or detailed photos other than the single one you provided specific advice cannot be given. However from your description, photo, and young age, I would recommend repositioning your  fat pads from an invisible incision just inside your lower eyelid (transconjunctival approach). By repositioning,a thin membrane called the arcus marginalis is released,  the fat is allowed to slide down filling in your hollowed area.  By using your own fat can remove or reposition your fat pads a fat transfer is usually not required.

Transconjunctival Blepharoplasty with Fat Graft for Eye Hollows

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Usually when belepharoplasty is done with fat positing, the fat is not injected. It is moved from one location to the other. If moved correctly, it is rare that it would dissipate. Other options would be using filler, which can give a very nice result. While it is difficult to tell from the photograph if you would be a good candidate for filler, there seems to be a distinct hollowing under the middle fat pad.  Hollowing often responds nicely to facial filler.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

Transconjunctival Blepharoplasty with Fat Graft for Eye Hollows? (photo)

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Hi and thanks for your question.

Looking at your photo you have significant midface ptosis. If you have a surgical solution you will need a cheek lift to reposition the malar fat pad. This is done in addition to lower lid blepharoplasty and fat repositioning of orbital fat. Fat grafting can be done as an adjunctive procedure and adds volume to the repositioned tissues.

Best Wishes

Transconjunctival Blepharoplasty with Fat Graft for Eye Hollows?

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      Fat repositioning transconjunctival blepharoplasty is not a bad option.  Fat grafting with fat removal transconjunctival blepharoplasty is not a bad option either.  I prefer laser or TCA peels over phenol peels for this area.  Kenneth Hughes, MD Los Angeles, CA

Lower lid blepharoplasty can make use of herniated fat can prove volume around the orbit.

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I think the best solution to your problem would be a blepharoplasty. In your case I think trans conjunctival or conventional are both legitimate. Either way it looks as though the fat that is delivered via blepharoplasty can be used for aesthetically favorable volume enhancement around orbit.

Transconjunctival blepharoplasty

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It looks like a transconjunctival blepharoplasty would be a great option for you. Different surgeons will have different preferences. Instead of grafting or repositioning fat I prefer to use Restylane injections several weeks after fat removal to help blend the eyelid-cheek junction if needed. I find this technique more reliable than fat grafting, but again this is my own personal preference. Best of luck.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 reviews

Correct lower lid bags

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Thank you for your photos and your question about your baggy lower lids.

  • you will do best with a lower lid blepharoplasty to trim/reposition the fat,
  • additional fat transplants should not be necessary, 
  • peels or lasers are only needed if the skin itself is loose,
  • any eye treatment has a rare risk of visual damage, 
  • Fillers are not as good an option as lower lid blepharoplasty whose results are permanent and quite predictable. . 
  • Hope this helps. Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.