Primary goal: Utilize (rather than remove) lower eyelid fat to fill in any depression that may be present at the junction between the lower eyelid and the cheek caused by the gravitational descent of soft tissues of the midface.
Secondary goals: Avoid the hollowed-out appearance that may result from aggressove lower eyelid fat removal as well as from on-going aging
Anesthesia: Deeper sedation may be required.
Operative technique: Fat repositioning is not so much a distinct operation as it is a different method of handling the problem of bulging fat during a blepharoplasty. The fat pockets may be approached surgically from either a transcutaneous or transconjunctival route, after which they are dissected free of their surrounding thin "capsules" but not removed. Most typically, the loosened fat is reflected over the rim of bone and advanced into any hollowness that may have developed from age-related descent of the cheek.
Variations: Rather than reflecting the fat layer over the bony orbital rim, it may be redistributed within the eyelid to even out imbalances that may have developed naturally or after injury or prior surgery. The reflected fat may be placed into a pocket dissected either above or below the periosteum (lining of the bone).
Limitations: See below. In addition, the technique is effective only in mild cases of cheek descent since the effect is subtle. Deeper hollow areas, especially towards the nose, may require placement of artificial implants rather than fat.
Care and recovery: Initial swelling and bruising may be increased due to the additional tissue manipulation. Swelling is slower to resolve and may be noticeable for several months.
Risks and complications: Additional risks are related to any uneven distribution of the repositioned fat at the time of reflection over the orbital rim. Because of the thin nature of lower eyelid skin, any irregularities will be visible. There are no long-term studies to demonstrate that such transferred fat will remain viable in its new position, but often it does seem to last.
