Blepharoplasty with fat transfer is a modern approach in eyelid surgery that ensures natural and youthful results. It diverges from the antiquated technique in which the main focus is to remove the excess skin and fat with little regard to age-related volume loss.
The antiquated technique may cause skeletonized eye socket appearance especially along the lower eyelid. This is particularly true when the fat is entirely removed, leaving no “carpeting” beneath the skin to promote smooth results.
To prevent creating or aggravating the hollowed lower eyelid, Dr. Tarick Smiley of the California Surgical Institute says he often incorporates blepharoplasty with fat transfer. The idea is to create a smooth transition between the lid and cheek, which is one of the key elements of a youthful face.
In Dr. Smiley’s recent Snapchat post, he has shown a female patient who has had upper and lower blepharoplasty with fat transfer.
The patient’s upper blepharoplasty was performed to eliminate the hooding of the lid; this was done with incisions made precisely at the existing skin fold to hide the resulting scar. Only a very small amount of skin was removed to preserve the function or “normal blink” and to allow for proper wound closure, which is the key to optimal hidden scars.
While some doctors extend the incision into the crow’s feet, Dr. Smiley keeps it within the natural skin fold of the upper lid to ensure that the scar will remain hidden.
The patient’s lower blepharoplasty surgery, on the other hand, was performed with an incision placed very close to the lower lash line so her eyelashes can hide the resulting scar. The area has a markedly thin skin, which allows the scar to fade better into the background.
Meanwhile, the antiquated technique removes the entire fat in an attempt to remove the under eye-bags; however, this causes hollowness right after surgery or years down the road, as soft tissue volume decreases with aging.
There are several ways to prevent the appearance of hollowed lower eyelid, with fat transfer being the most popular option, says Dr. Smiley.
Other patients can benefit from the repositioning of their superficial fat (fat beneath the skin; this is different from the deeper “bulging” fat that often requires removal), specifically laying it over the upper cheekbone to maintain a smooth lid-cheek junction. Fat grafting or injecting can further fine-tune the results.