Fat Transfer Lower Blepharoplasty

Fat transfer lower blepharoplasty is appropriate when there is descent of the midface, or an overall lack of volume beneath the eyelids.  For a long-lasting effect, it can be helpful to keep the fat from the lower lids (eye socket fat) attached to it’s natural blood supply, so that it doesn’t get absorbed.

Fat transfer is definitely important in older men.  A hollow postoperative appearance in the male is one of the worst outcomes from cosmetic surgery.  Several celebrities come to mind.  It can be important in women as well.

The drawback with fat transfer blepharoplasty is the duration of healing after the surgery.  In general, the lower lids retain a small amount of edema and mild discoloration for several weeks after fat transfer blepharoplasty of the lower lids.  However, in the right patient population, the long-term benefits far outweigh that inconvenience.

Below are two case vignettes:

Patient 1: This gentleman is older and has vision impaired from his upper lids, as can be seen in the preoperative photo.  Vision was impaired to the degree that insurance paid for his upper blepharoplasty.  At the same time, he complained about the excess tissue bags in the lower lids:

Preoperative:

The surgical plan was to perform upper blepharoplasty, in addition to lower blepharoplasty with the follow customizations:

• Open incision (transcutaneous) approach
• Canthoplasty
• 40% fat removal / 60 % fat transfer
• Retinacular suspension

Postoperative (3M):

The postoperative course was uneventful, and he is seen postoperatively at 3 months.  There are still a few months of (subtle) healing left, but his result at this point is quite favorable.  There is good volume in the lower lids, but it does not make him look tired; it has a much more youthful appearance.

Patient 2:  This woman had visually significant ptosis of the upper lids.  Insurance was utilized to correct her upper lid position.  At the same time, she wanted a more youthful appearance to her lower lids:

Preoperative:

The surgical plan was to perform upper ptosis repair and blepharoplasty, in addition to lower blepharoplasty with the follow customizations:

• Open incision (transcutaneous) approach
• Canthopexy
• 100 % fat transfer
• Retinacular suspension

Postoperative (3M):

The postoperative course was uneventful, and she is seen postoperatively at 3 months.  There are still a few months of (subtle) healing left, but her result at this point is quite favorable.