his eye bag surgery with fat repositioning a good procedure people
considering lower eyelid surgery to treat puffy eye bags are often concerned
about the potential for a hollow appearance after surgery some doctors
try to ease this concern by saying that the fat causing puffy eye bags instead
of being reduced can be repositioned to an area around the eyes where there is
Halloween as a cosmetic eyelid surgery specialist I have experienced with this
procedure as well as performing revision surgery for people who had fat
repositioning surgery performed elsewhere I'll explain how I helped my
patient to express a concern about potential hollows after lower eyelid
surgery and what the risks of fat repositioning surgery are in comparison
to alternative options I'm Dr. Amiya Prasad I'm a
Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I've been in practice in Manhattan and Long Island
for over 20 years I perform upper and lower eyelid surgery pretty much every
day in my practice as well as revision eyelid surgery to correct work
originally performed by other doctors I also perform routinely non-surgical
eyelid procedures such as laser resurfacing fillers and platelet-rich
plasma or PRP puffy eye bags that are present all the time regardless of sleep
allergies diet or sinus issues are caused by fat the fact that normally
surrounds and cushions around the eyeball can push forward resulting
invisible bulges under the eyes and is referred to as lower eyelid fat prolapse
the most definitive way to address the parents of eye bags is to sculpt and
reduce the fat causing these bulges sculpting and removing fat from the
lower eyelid is done surgically with the procedure called lower eyelid
blepharoplasty the most common perform procedure is
called a transcutaneous blepharoplasty where fat is sculpted and removed
through an incision made underneath the eyelashes a more specialized and
technically advanced procedure which I prefer is called transconjunctival
blepharoplasty where there is no external incision and the fat is
sculpted from the inside of the eyelids the transconjunctival method is
advantageous for the patient as there is no outside incision since I performed
this procedure from the inside of the eyelid I'm preserving and protecting the
delicate muscles and support structures of the lower eyelid I'm able to
therefore minimize the risk for common complications such as the eyelids being
pulled downward or rounding which is referred to as lower eyelid retraction I
found that for many people the definition of hollowing is the
appearance of lower eyelid retraction this makes sense since when the eyelids
are pulled down the look is drawn or Hollow frequently people with eye bags
have hollowing in other areas around the eyes such as the rim of the eye socket
or the upper cheek a doctor may offer lower eyelid blepharoplasty with fat
transposition to fill this area of the tear trough and the adjacent bony rim in
during surgery what's called a pedicle of fat which means the fat is still
connected to the blood supply from the eye socket is moved over the rim and
sutured into the area some doctors cut the fat and place it in there and just
suture it freely this all may sound logical and intuitive but it is
generally actually problematic why first the eyelid skin is very thin so
the area can easily appear lumpy and swollen the blood supply by being bent
over the rim is effectively compromised which means the fat can swell similarly
to the way your arm would swell if you left a tourniquet on too long the
bending or kinking of blood supply can also deprive the fat of oxygen and
nutrition which results in the fat dying this repositioning concept is not new in
oculoplastic surgery this concept was being explored in the mid-to-late 90s at
that time we didn't have hyaluronic acid fillers further the doctors who were
strong proponents of this procedure initially later stated that they were no
longer performing fat repositioning this doesn't stop or didn't stop other
doctors and other specialties too cyclically
reintroduce this concept in my opinion it's more of a marketing tool than
anything else I've watched a surgeon who claimed to be a top expert demonstrate
this procedure he proceeded to remove 90% of the prolapsed fat and take a
small and insignificant fat pedicle for the so-called transposition or
repositioning any experienced surgeon would know that the fat repositioning
that was done by this doctor was not going to make any difference in the
aesthetic outcome patients reported to me that when they come in to see me for
a second opinion after fat transposition surgery
performed elsewhere that they experienced prolonged swelling and
lumpiness which required steroid injections by their doctor if there is
one thing people have limited tolerance for these days
it's unpredictability I approach rejuvenation for the under eye bags
during consultation but also looking at the projection of the cheek directly
under the eyes as well as the cheekbones I look at the eyes and cheeks as a
combination rather than looking at the eyes in isolation it is commonly seen
whether the cause is genetics or the causes bone loss from facial aging for
there to be a potential space under the eyes and cheek bones from volume
enhancement as a surgeon with experience performing tear trough implants and
cheek implants I apply the same principles to the application of a
longer lasting hyaluronic acid fillers on to the bone structure a method we
call Structural Volumizing I routinely use a filler like the Juvederm Ultra
plus or Juvederm Voluma to enhance the cheekbones at the same time I perform
lower eyelid surgery as mentioned earlier by maintaining the shape the
lower eyelid and avoiding the hollow look of lower eyelid retraction and also
enhancing the cheekbones my patients are very much satisfied with their
appearance after surgery if there is a potential benefit and adding volume to
the tear trough later we can always do that
unlike fat transposition hyaluronic acid fillers can be safely and easily
dissolved if needed with an enzyme called hyaluronidase addressing the
puffy eye bags is not a standardized procedure and there is an art to
achieving natural results the goal is to have an appearance as if you never had
bags under your eyes I routinely perform transconjunctival lower eyelid
blepharoplasty and my private office operating facilities using local
anesthesia and LITE IV sedation our patients walk out of our office
comfortably and return to work typically one week although the concept of fat
repositioning has a certain intuitive appeal there is little justification for
this procedure as it is often promoted although not practiced as claimed in
actuality in my opinion if you have under-eye bags
a properly performed surgery combined with other procedures such as the
placement of fillers can help you look better in a safe and predictable way I
hope you found this information helpful thank you for your question
you