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Topic 20 - 3
Lower Fat Repositioning:
Robbing Peter To Pay Paul  
arcus marginalis release photos Lower Eyelids cheek and midface lift


rob Peter to pay Paul


To use resources that legitimately belong to or are needed by one party in order to satisfy a legitimate need of another party, especially within the same organization or group: to solve a problem in a way that makes another problem worse, producing no net gain.


While terms and concepts like "fat preservation" or "fat conservation" have a certain ring to them, such terminology can sometimes be misleading.

Relocating orbital fat out of its socket, through the eyelid, and then onto the surface of the cheek bone is not preserving fat in its anatomically-correct compartment. As far as the eyeball and socket are concerned, transferring fat onto the cheek is no different than removing it.

The most common adverse outcome is the inadvertent creation of either immediate or late term eyelid hollowness.

A common misconception is that fat redraping is somehow superior to fat removal and more anatomically "responsible." In fact, it's a good example of "robbing Peter to pay Paul."

Both fat excision and repositioning entail removing fat from its natural location within the orbit. While either technique may result in hollowing of the orbit and eyelid if overdone, it is much easier to do so while trying to camouflage a cheek hollow, both because of the need to mobilize more fat than may be safely expendable as well as later shrinkage, or atrophy, resulting from excessive surgical manipulation.

Orbital hollowness is a much more serious eyelid deficiency than cheek thinning and is very difficult to treat. Following a growing stream of young patients referred to us for hollowness revision surgery after lower blepharoplasty with fat repositioning, we came to completely discontinue the procedure in our practice.

Besides, with the ongoing refinement of injectable dermal fillers to treat cheek hollowing, lower eyelid fat repositioning has lost much of its previous lustre.

Next: Cheek and
Midface Lift

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