These are the 3 main ways fat can be managed during lower eyelid blepharoplasty:
1. Fat Excision: This technique is all about removing excess fat to reduce puffiness in the lower eyelids. I typically reserve fat excision for older patients, especially men with strong facial features, where softening the under-eye area too much would create an imbalance with the rest of the face. However, if there’s hollowing in the tear trough area, which most patients tend to have, fat excision alone won’t address that loss of volume.
2. Fat Grafting/Fat Transfer: This is where fat is harvested from other areas like the belly or thigh and injected under the eyes to replace that volume loss. While this technique is useful for patients with significant loss of volume, I generally avoid it as a primary choice in the majority of patients. The reason is this: since the fat is disconnected from its blood supply, we typically lose about 50% of it after transfer, making the results unpredictable and sometimes leading to lumps or bumps. Additionally, grafted fat can respond to weight changes, so I tend to avoid it, especially for younger patients, where long-term stability is key.
3. Fat Repositioning: This is the most complex of the three techniques but, in my opinion, gives the best results. With fat repositioning, most of the under-eye fat isn’t removed; instead, I release the tear trough attachments and carefully move the natural eyelid fat down to fill in the hollows. This allows for a smoother transition from the eyelid to the cheek, reducing both the under-eye bags and the tear trough hollows while also minimizing dark circles. Since this fat is native to the eyelid, it is usually not affected by weight changes, and, by keeping it connected to its blood supply, we can achieve a more predictable, natural, and long-lasting outcome with this technique.
If you’re considering lower eyelid surgery, it’s important to discuss these options with your surgeon. And if they don’t offer fat repositioning, definitely ask why—it’s much simpler to excise or transfer fat, but in the vast majority of cases, repositioning provides the most stable, natural-looking results, especially when performed by an eyelid expert.
Stay tuned for Part II, where I discuss how to manage the under eye skin wrinkles and folds.
Dr. Abboud is an oculofacial plastic surgeon in San Diego who is an expert on cosmetic eyelid surgery. He is board-certified by the American Board of Ophthalmology (AAO) and is a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).
For more information about under eye rejuvenation or to schedule a consultation with Dr. Abboud for personalized advice on eyelid surgery, call our office at 858.356.2647
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