Before

Analysis: While this patient's tear trough deformities and the depressions between her lids and upper cheeks are quite deep, her lower eyelids also contain a substantial amount of bulging fat. To surgically address only one of her problems while ignoring the other would worsen her appearance in that:

(1) If only bulging eyelid fat is removed, the look of hollowness will be effectively "magnified" by visually extending the apparent areas of tissue deficiency, or

(2) If only the areas of hollowness are plumped up with fillers (commercial preparations or fat injections) without reducing the nearby bulging, the eyelids will appear extremely puffy.

Solution: The solution was to address both problems simultaneously by utilizing bulging fat to help fill in the adjacent areas of hollowness.

Four Months After

(Surgery by Dr. Frank Meronk)

Because repositioned fat is minimally traumatized and still connected to its blood supply, its "take" is more predictable than free fat injection.

Comment: Improvement is subtle at best while the risk of hollowing the eyelid by moving out too much orbital fat is very real. The advent of safe, easy-to-use, and longer lasting injectable fillers into the areas overlying bone of the upper cheek has muted our previous enthusiam for this much more invasive approach.

View eyelid fat repositioning step-by-step in another patient
Caution: Actual surgery photos