<Lower Blepharoplasty Part 2> Fat Removal? Fat Repositioning? In Search of Lively Lower Eyelids...

Hello!

I am Kim Sung-hoon, a board-certified plastic surgeon and facial designer.

This post continues from the previous one, discussing lower blepharoplasty fat removal and fat repositioning. Some say fat should be removed, while others argue against removal, advocating for repositioning. What is the correct approach?

In the previous post, I discussed the outcomes of lower blepharoplasty.

<Outcomes of Lower Blepharoplasty>

▶Fillers, fat grafting

→ May improve or worsen

▶Fat removal only

→ 100% recurrence or complications

▶Fat repositioning only

→ Low surgical satisfaction

▶Fat repositioning + septal reinforcement + midface lift (± small amount of fat removal if necessary)

→ Long-term improvement and high satisfaction

Why does fat protrude under the eyes? Dr. Siew's illustration from Singapore provides a quick understanding.

①Stretched septum

─ The septum, which prevented fat from protruding, stretches and can no longer contain the fat pockets.

②Orbital fat protrusion

─ Fat protrudes through the stretched septum.

③Midface fat sagging

─ Fat in the midface sags, worsening nasolabial folds and causing the midface to appear hollow.

Therefore, to achieve improvement in lower blepharoplasty, all of the following must be performed: fat repositioning + septal reinforcement + midface lift (± small amount of fat removal if necessary).

1. Fat Removal

Why remove fat that was previously not an issue? My answer is, ‘It is not advisable to unnecessarily remove fat.’

Looking at the photo above, the client underwent only fat removal. While the protruding fat is gone, the removal of fat that supported the eyeball led to orbital hollowing, causing the eyelids to sink and the double eyelid crease to become smaller. Furthermore, the orbital bone became more prominent, resulting in a gaunt or tired-looking appearance.

2. Fat Repositioning

What about fat repositioning, which has become popular in the last one to two years? Of course, it yields much better results than fat removal. However, it cannot fill the sunken midface, so while there is improvement, there is often a lingering sense of something missing.

With fat repositioning, the tear trough and prominent fat pockets are gone, but the deeply sunken midface remains, leaving a slight lack in the feeling of rejuvenated or beautified lower eyelids.

We have explored the results of fat removal and fat repositioning, commonly performed in lower blepharoplasty. In the next post, I will discuss the complete version of lower blepharoplasty: ‘Fat Repositioning + Septal Reinforcement + Midface Lift’ in detail.

I will always strive to be a plastic surgeon who is honest and truthful.

Thank you.

<Contact Us>

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