Lower eyelid blepharoplasty has traditionally consisted of the excision of excess skin/muscle and fat from the lower eyelids.  What was identified over time is that tissue removal – especially fat – eventually led to a gaunt or hollowed appearance which actually accelerated the aging process rather than re-creating youth.  Over the last decade a paradigm shift has occurred among cosmetic eyelid surgeons (ophthalmic plastic surgeons or oculoplastic surgeons).  This shift is towards preserving eyelid fat rather than removing it.  Actually a better word is redistributing eyelid fat from areas of excess to areas of deficit.  This has allowed not only the reduction of  prominent  lower eyelid “bags,” but also the simultaneous filling of lower eyelid depressions or grooves (typically under the bags) with this fat.

A major groove which causes concern to many patients is the tear trough (or nasojugal groove).  It is present under the lower eyelid fat bag near the nose (on the inner part of the lower eyelid/cheek junction).  This depression cannot be corrected by fat removal only.  This is one of the areas of the lower eyelid which can be filled with Restylane or Jevederm if surgery is not desired (see link https://drmassry.com/blog/?p=176) .

In fat repositioning lower blepharoplasty the lower eyelid fat pads are shifted into the tear trough under the skin to fill the depression.  The fat acts like a filler but is one’s own tissue.  It does not dissolve over time like the fillers we inject.  The surgery is more complex and delicate than normal fat excision lower eyelid blepharoplasty – but the results are superior.

I believe that facial/eyelid fat is precious and should be preserved as much as possible to prevent long term hollowing of the eyelids (a very unattractive appearance).  Sometimes fat does have to be trimmed a bit, but more often than not, there are as many areas of depression which need this fat as there are areas of fat excess.  Typically fat repositioning (shifting) redistributes the fat appropriately to significantly improve eyelid contour.

Below is an example of a young woman who presented with lower lid fat prominence and an associated depression below (tear trough or nasojugal groove).  She underwent lower blepharoplasty with fat repositioning by me in addition to a midface (cheek) lift.  Note the significant improvement is lower lid appearance after surgery with reduction of lower lid bag and filling of associated tear trough (depression below bag).

Before My Surgery          After My Surgery

Lower lid blepharoplasty with fat repositioning is an intricate procedure which should only be performed by a cosmetic eyelid specialist.