Fat Transfer or Fat Repositioning

Role of fat repositioning or transfer in blepharoplasty

  • Aging causes a gradual descent of {the} eyeball and subsequent pseudo-herniation or sensation of bulging of fat within {the} orbit and produces a double-convex lower eyelid contour on profile view. Aging also causes thinning and drooping of {the} eye muscles, particularly orbicularis oculi muscle and cheek fat giving your eyes {the} typical droopy and baggy eyelids. Various techniques have been used to reduce lower eyelid herniated fat, one of which is lower trans-conjunctival blepharoplasty. It is now {the} preferred method of treating lower eyelid herniated fat with clearly better response than traditional techniques.
  • Fat transfer is variously known as fat repositioning, fat injection, fat grafting or fat transposition. This procedure is an inherent part of any eyelid surgery for facial rejuvenation that promises to endow a youthful mid-face appearance.
  • Fat transfer simply involves {the} shifting of redundant fat from locations where it is least required to other locations where it would make a world of difference.
  • Cosmetic lower lid rejuvenation involves {the} use of fat repositioning to bring about fullness and life into {the} skeletonized, hollow and dry lower lid seen with advancing age.
  • The craze for hidden suture-lines during surgery has caught {the} fancy of thousands of individuals who are willing to go under {the} knife with a hope for a fresher, younger look.

Understanding {the} Basis of Fat Repositioning

  • Lower eyelid herniated fat is {the} cause of sunken or hollow appearance of your eyelid, particularly if you have something called a tear-trough deformity. In this deformity which is may also be called nasojugal fold, there is a hollow at {the} medial and lower boundary of {the} eyeball socket due to {the} inferior descent of {the} cheek with age or due to an anatomic bony deficiency of {the} maxilla or cheek bone. This is supplemented by a double-convexity contour deformity or bulging which includes {the} lower eyelid herniated orbital fat bulge and {the} cheek/malar mound bulge.
  • Technically speaking, fat repositioning is defined as {the} subperiosteal repositioning of {the} medial and central lower lid herniated orbital fat into {the} nasojugal fold. In simple words, bulging fat within {the} eyeball sockets are placed in places where there is hollowness or sunkenness. The lateral orbital fat pad could be repositioned into {the} lateral inferior orbital region if needed. During fat repositioning, {the} tear trough is clearly demarcated before {the} surgery.



Who should undergo Fat Transfer or Fat Repositioning Procedure?

Individuals or patients with any of {the} following conditions are suitable candidates for fat transfer or fat repositioning procedure:

  • Herniation of lower eyelid fat
  • Individuals with tear-trough deformity
  • Individuals who would accept possible risks and complications
  • Individuals with realistic expectations about {the} outcome of surgery.

Fat repositioning procedure should be undertaken only after proper counselling regarding all possible outcomes of surgery.

How does a Fat Transfer or Fat Repositioning improve outcome in Blepharoplasty?

Fat transfer or Fat Repositioning procedure, particularly {the} transconjunctival variety, benefits patients in one or more of {the} following ways:

The bony outline of {the} eyeball socket is covered up using {the} periorbital fat to provide a thicker cover to reduce skeletonization or sunkenness thus enhancing {the} youthful appearance of {the} periorbital region.

  • Even modest fat removal in patients with underdevelopment of {the} eyeball socket rims could synergistically improve {the} prominent appearance of {the} eyeballs. Mobilizing fat over {the} rim enhances {the} coverage of {the} orbital bony rim and elevates {the} sunken area helping to camouflage some of {the} prominence of {the} globes.
  • Orbital fat could be mobilized below {the} attachment of {the} levator labii superioris alaeque nasi to efface {the} contour of depression seen in a prominent nasojugal groove..
  • Regular blepharoplasty or eyelid surgery results in a sunken-eye appearance as it unmasks {the} inferior rim of {the} eyeball socket which was previously hidden by prolapsed fat. Fat transfer or repositioning in deep-set eyes with fat protrusion during transconjunctival blepharoplasty produces a good cosmetic appearance of {the} entire eye.

What are {the} possible advantages and disadvantages of Fat Repositioning?

  • Fat repositioning is advantageous in preventing {the} development of tear-trough deformity or more often, it is used for {the} treatment of herniated orbital fat with minimal risk of complications.
  • However, fat repositioning has its disadvantages in being difficult to master, with a steep learning curve. Poor fat repositioning by an inexperienced surgeon is associated with complications such as double vision due to inadvertent inferior oblique muscle injury, development of fat granulomas, prolonged oedema or swelling and occasionally, permanent irregularities of soft tissues.

Summary Fat Transfer or Fat Repositioning Procedure

  • Transcutaneous lower blepharoplasty has been replaced by transconjunctival blepharoplasty surpassing {the} former in terms of patient satisfaction and fewer complications. This change has heralded {the} use of fat transfer or fat repositioning as an integral procedure with transconjunctival lower blepharoplasty.
  • However, {the} use of transconjunctival blepharoplasty is limited by {the} fact that there is a significant learning curve associated in using this technique.
  • Fat transfer or fat repositioning has thus become a rising star in eyelid surgery in recent times.


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