Lower Blepharoplasty surgery traditionally consisted of the excision of fat from the lower eyelids (eyelid bags).  Over the last decade we have learned that preserving fat with fat grafting to the eyelids, or repositioning one’s own eyelid fat (lower lid blepharoplasty with fat repositioning) is a better option as it prevents postoperative eyelids hollows.  Fat repositioning is an advanced eyelid technique which yields excellent results to surgery.  Dr. Guy Massry, a cosmetic eyelid specialist in Beverly Hills performs many of these procedures every month.  He is an expert in fat repositioning surgery, and has published extensively on the subject http://www.drmassry.com/pdf/comp%20ll%20rejuv%202010.pdf,  http://www.drmassry.com/pdf/sculpting%20the%20eye.pdf

Dr. Massry recently has completed his second textbook in the field which covers this topic extensively. Open this link for information on the upcoming text. http://www.springer.com/medicine/ophthalmology/book/978-1-4614-0066-0?detailsPage=authorsAndEditors

Below is a surgical series demonstrating how fat is repositioned in surgery.  In (A) the fat is made into flaps to place into the lower eyelid hollows.  On the right side illustration you can see the muscle sandwiched between two fat pads, and the bone exposed where the fat will be placed.  In (B) the fat flap is engaged with a suture so that it can be redirected over the bone.  In (C) you can see the fat pads over the bone and muscle acting as an implant to fill the hollow.


Below is an example of a patient who had this surgery performed.  Note the significant reduction in eyelids bags and improvement in hollows (dark circles)