What are the pros and cons between fat graft versus blepharoplasty?
I have been to about 15 different doctors.
I got 15 different answers.
What are the pros and cons?
Does fat grafting last?
Is blepharoplasty too severe?
I am a 37 years old Caucasian woman.
Thank you.
Thank you for your question.
You’re asking about the pros and cons of lower eyelid blepharoplasty versus fat grafting
and you’re asking about longevity.
And I am particularly appreciate the fact that you went ahead and saw 15 doctors and
you’ve got 15 different answers.
So clearly you have learned that cosmetic surgery is not a commoditized type of thing
where if you could choose to have a procedure and that is equal amongst doctors.
Everyone comes to the table with a perspective and that’s a good take home message and
unfortunately it has led you to a lot of confusion.
So I’m going to share with you my perspective based on the single photo you’ve submitted.
So what do we see in this photo?
We see someone with relatively prominent eyes, we see someone with relative puffiness under
the eyes and hollowness below the eyes in terms of the eyelid-cheek junction and the
cheek area.
So I think that the key to coming up with the best plan for you is by really identifying
in your mind the priorities of what affects you the most in terms of your appearance.
It is always tempting to have multiple procedures at one time but what I ask my patients to
do is to look at the mirror and the typical question is “Doc, what do you think I should
do?”
I give them the mirror and I say “Where do you look at first?
What draws your attention first?”
And very often we can isolate the top two to three priorities and address them conservatively.
I believe strongly in minimal trauma and trying to get the goals clearly defined.
You got 15 different answers from 15 different doctors because when we look at a patient
we bring to the table our own aesthetic, our own perception of what you need and of course
what the end result will be.
Unfortunately, I do see a good number of patients who come in to my practice and are distract
because they had procedures done by another doctors which I feel were technically very
well done but there was a disconnect between what they wanted and what they ended up having.
So even though I look at them and I think they look good for example they may have gotten
a brow lift and they feel like their expression has changed permanently; they may have gotten
excessively pulled from a face lift; they may have gotten fat grafting and now they
look amorphous and irregular.
So let’s just answer the question about fat grafting first and I’ll just share with
you my perspective.
When it comes to the lower eyelid area, I feel that fat grafting is too unpredictable
for this area.
Although theoretically or technically it makes sense to try to restore fat in the lower eyelid
area the fact is in under the skin of the lower eyelid there’s never been a lot of
fat.
There’s the puffiness that’s under the eyes that is orbital fat and that’s fat
in the space around the eye.
And it really doesn’t make sense to try to fill out the lower eyelid with fat.
The challenge is that not only the skin of the eyelid is so thin that little bumps and
irregularities are more common for those who have the fat grafting and some of the fat
makes it and some of the fat doesn’t.
With any discussion about fat grafting it is well accepted amongst cosmetic doctors
that 30-70% of that fat can get absorbed which means that in a place like the lower eyelid
where the skin is so thin and it shows all irregularities that you may end up with an
undesirable result.
I always tell my patients about people who come to me from all over the world who have
had fat grafting and they end up with lumps and bumps and then the challenge is to try
to get to those grafts through different planes of the eyelid in order to reduce the irregularities
and very often that results in potential destabilization of the eyelid structure and requires more
than one surgery.
So I would advise against fat grafting directly under the eyelid.
Now I do like fat grafting in the cheek area, in the nasolabial fold and in other areas.
And the reason is that those areas the skin is thicker and therefore you are able to place
the fat in a place that is likely even with variable absorption to not show irregularities.
I think that when you’re dealing with a face that is relatively hollow and since you
showed a limited view we have to also consider other lifting procedures whether it’s a
face lift, whether its volume augmentation in the cheek area or placement if even submalar
or cheek implants.
So there are certainly many options to explore in dealing with the lower eyelid puffiness,
that slight bit of puffiness.
If that draws your eye then a limited blepharoplasty such as a transconjunctival blepharoplasty
with some reduction of that fat may help you feel like a bet you don’t have the puffiness
under the eyes.
The other challenge is of course with relatively prominent eyes, the cheeks.
This is the only way to tell really is by side view but I could probably estimate that
what you have is something called a negative vector.
That means from a side view the eyes are more prominent than the cheek bone and that puts
you at relative risk for other complications related to lower eyelid surgery.
So in the mix of all of this and to help you understand my perspective about fat grafting
I would say that if you are going to choose to have fat grafting don’t have it done
in the lower eyelid, have it done in the face and other areas.
And as I discuss with my patients always be prepared for more than one procedure if you
have a very specific outcome or desired result.
And there are alternatives to fat grafting on the face such as the placement of submalar
implants to add volume in this area often referred to as the apple of the cheeks.
And again think about your priorities and find a doctor that you resonate with and maybe
take smaller steps.
You know when things get overwhelming then it is safer to try smaller steps and maybe
be more conservative in the beginning before you move forward with a more global, a more
extensive type of procedure.
So I hope that was helpful.
I wish you the best of luck and thank you for your question.