Fat Transfer & Repositioning
Traditional blepharoplasty removes orbital fat to reduce lower eyelid bags — but this can leave the eye looking hollow or skeletal. Fat repositioning takes that same fat and moves it over the orbital rim to restore volume and eliminate the tear-trough shadow, producing a more natural, youthful result.
The Problem with Simple Fat Removal
With age, the orbital septum weakens and the three lower eyelid fat compartments herniate forward, creating the characteristic “bags.” Removing this fat corrects the bulge but can unmask the orbital rim, creating a tear-trough deformity — the hollow groove between the lower lid and cheek that makes patients look tired or gaunt.
Fat repositioning addresses both problems simultaneously: the prolapsed fat is released from the orbit, draped over the inferior orbital rim, and secured in the nasojugal groove, filling the hollow and eliminating the double-convexity contour.
Techniques
Transconjunctival Fat Repositioning
Approached through the inner surface of the lower lid (no skin incision), the medial and central fat pads are released from the orbit, passed beneath the orbicularis muscle, and sutured in a subperiosteal pocket over the orbital rim. This is the preferred technique — no external scar, reliable volume restoration, and faster healing.
Transcutaneous Fat Repositioning
Used when concurrent skin removal is needed. The skin-muscle flap approach allows access to fat and simultaneous trimming of redundant lower lid skin. Requires precise tension-free closure to avoid ectropion.
Fat Grafting (Micro-Fat Transfer)
In patients with deep tear troughs without significant fat herniation, fat harvested from the abdomen or thigh can be injected into the periorbital hollow. Results are excellent but require a second harvest site and some volume is lost to resorption.
Ideal Candidates
- ›Patients with lower eyelid fat herniation causing a convex bag-to-cheek contour
- ›Individuals with tear-trough deformity (nasojugal groove hollowing)
- ›Patients who want volume restoration rather than a purely subtractive result
- ›Patients without significant lower lid laxity (which requires concurrent canthoplasty)
Risks
- Prolonged swelling — fat repositioning carries slightly more edema than simple excision; most resolves by 4–6 weeks.
- Contour irregularity — over- or under-correction of volume; most amenable to secondary touch-up.
- Inferior oblique injury — the inferior oblique muscle passes near the medial fat compartment; inadvertent injury causes temporary diplopia.
- Fat granuloma — rare; presents as a palpable nodule months after surgery.
Schedule a Consultation
Dr. Brown will examine your lower eyelid anatomy and recommend whether fat repositioning, excision, or a combination is right for you.