Fat repositioning vs fat removal from lower eyelids. Which is best for me?
HI I’m a 33-year-old and I have little fat bags under my eyes. I had a consultation with
2 different plastic surgeons. One of them said it will be best to reposition the fat
and remove little skin & the second one said that he will remove all the fat via transconjunctival
approach as I don’t have enough fat to reposition and the recovery in surgery to reposition
runs in months. And now I am confused. Here, I have seen many skilled cosmetic surgeons.
I’m requesting an oculoplastic surgeon to please tell me the best approach for me.
Thank you for your question!
You submitted photos and you’re 33 years old, you’re asking an oculoplastic surgeon
to help you make a decision on whether or not to choose one doctor’s opinion, recommendation
which was to take the fat that’s under your eyes, reposition and remove some skin or another
doctor’s opinion who said you don’t have enough skin to remove and to have a routine
lower eyelid blepharoplasty from the inside and reduce the fat.
Well, again, I am an oculoplastic surgeon. I’ve been practicing in Manhattan and Long
Island for over 20 years and cosmetic lower eyelid surgery is probably the most common
thing we do in addition to several other specialty areas in our practice. I’m going to help
you understand the thinking especially from somebody who’s been in this field for so
long.
The concept of transposition of fat has a natural appeal to the lay person. In other
words, the doctors who very openly advocate for it appeal to this intuitive belief that
taking out fat can make you hollow and therefore, let’s take the fat and move it. Now the
similar logic was used a few years ago by another set of doctors who believed that the
best way to treat under eye bags was to transfer fat, to take fat from another area and put
it under the eyes.
So as a specialist who takes care of a lot of complications, I’ve seen transposition
patients who have had lumps and irregularities below the eyelid and that chronic swelling
as what you have described in your question, very common. I’ve had patients who had fat
grafting, end up with lumps and irregularities and both types of patients had needed me to
revise their surgery. So in the modern world, it is very important, particularly because
of the time frame that people need to look their best and go back to their normal life.
You have to choose a procedure, in my opinion, that’s predictable and will allow you to
get back to your normal life.
So in my hands, a patient like yourself, this procedure I would do as a transconjunctival
blepharoplasty. It means going behind the eyelid. I would not do transposition. I would
sculpt and reduce the fat so it doesn’t protrude and create a bulge. I would also
use adjuvant treatment such as platelet-rich plasma. This is derived from your own blood
and we use it routinely to help stimulate and improve skin quality as well as to address
skin texture and dark circles under the eyes which are all interrelated and once that’s
done, you are done and most people go back to work in less than a week. We also perform
these procedures under local anesthesia with LITE™ IV sedation. That means you’re not
under general anesthesia.
Having done so much surgery for over 20 years, I can tell you that this approach has been
successful for me. Now does that mean that the doctor who recommended transposition is
wrong? Not necessarily. I can tell you that a lot of doctors who’ve claimed to have
done transposition, one of the patients came to me in my practice for a second opinion.
I reviewed their operative reports and etc I saw no evidence of transposition. It doesn’t
mean that they didn’t do it, it means that they’ve tried to do it and the fat just
retracted back to its original position. And I would agree with the doctor that there’s
a certain amount of swelling that a patient has to be prepared for and there has to be
a justification.
When we look at people and consider the puffiness, we also look at the big picture and look at
the interrelationships of volume in the eyelid to cheek junction. We look at volume in the
malar and sub-malar area. The whole is greater than the sum of its parts and it’s always
not the case that one surgery serves all issues. For many patients particularly male patients,
taking away the negative of under eye puffiness is satisfactory enough. Once they don’t
have the bags under the eyes, they’re very happy and we have the experience to validate
that this works.
So doing a procedure that’s predictable, consistently successful and gets you to you
to your normal life quickly, in the modern world is more valuable than it’s ever been.
Patients who have had, like I said, transposition or fat grafting, very often do have chronic
swelling and that chronic swelling is very hard to live with. People don’t have that
kind of tolerance even less now than they ever had before. So I will suggest that you
think this through and discuss this again with the doctors and get additional opinions
but from my perspective, this would be my recommendation.
So I hope that was helpful, I wish you the best of luck and thank you for your question!