What is the best technique for undereye rejuvenation surgically? regular blepharoplasty, fat reposition or fat transfer?

The best surgical technique for under-eye rejuvenation depends on several individual factors — including anatomy, skin quality, fat volume, and the presence of tear troughs or hollowing. Each of the three main techniques — traditional blepharoplasty, fat repositioning, and fat transfer — has its pros, cons, and ideal candidates.

Here’s a comparison to help determine the best approach for a given situation:

🔹 1. Traditional Lower Blepharoplasty (Fat Removal)

What it does: Removes or debulks herniated orbital fat and tightens lower eyelid skin (often via transcutaneous or transconjunctival approach).

✅ Best for:

• Patients with significant under-eye puffiness or fat prolapse.

• Patients with minimal to moderate hollowing.

• Those with excess skin or wrinkles (transcutaneous approach may include skin excision).

➕ Pros:

• Long-standing, well-understood procedure.

• Effective in reducing bulges or bags.

• Can be combined with skin tightening.

➖ Cons:

• Risk of over-resection, which may cause a hollow or sunken look.

• May not correct tear trough deformities well.

• Potential for eyelid malposition if not done conservatively.

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🔹 2. Fat Repositioning

What it does: Repositions orbital fat (instead of removing it) into the tear trough or infraorbital hollow to smooth contour.

✅ Best for:

• Mild to moderate fat prolapse and tear trough/hollowing.

• Patients wanting a more natural, smooth contour.

• Younger or middle-aged patients with good skin elasticity.

➕ Pros:

• Maintains volume (avoids "hollow eye" look).

• Smooths the lid-cheek junction naturally.

• Avoids need for filler or fat grafting in many cases.

➖ Cons:

• Technically more demanding.

• Slightly higher risk of lumps or irregularities.

• Not ideal if skin excess is a major issue (may require combined approach).

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🔹 3. Fat Transfer (Autologous Fat Grafting)

What it does: Fat is harvested from another body area (e.g., abdomen or thighs) and injected into tear troughs or midface.

✅ Best for:

• Patients with volume loss or sunken eyes.

• Those seeking fuller, more youthful under-eyes without significant fat prolapse.

• Can also be used after blepharoplasty or for touch-up/revision.

➕ Pros:

• Restores volume naturally.

• Can rejuvenate skin via stem cell effects.

• Longer-lasting than fillers.

➖ Cons:

• Unpredictable fat survival (30–70% retention is common).

• Risk of lumps, nodules, or overcorrection.

• Not ideal as a stand-alone treatment for large fat prolapse or excess skin.

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🔍 So, What’s the Best?

Patient Type	Best Approach
Young patient with bags but no hollows or loose skin	Transconjunctival blepharoplasty (fat removal or reposition)
Mild fat prolapse + tear trough hollowing	Fat repositioning (± conservative skin pinch if needed)
Deep hollows, volume loss, little fat prolapse	Fat transfer
Fat prolapse + excess skin	Transcutaneous blepharoplasty with fat reposition or conservative removal
Revision case or hollowed-out look from previous surgery	Fat transfer or filler touch-up

🧠 Expert Consensus

Most modern oculoplastic and facial plastic surgeons prefer fat repositioning over removal for suitable candidates, as it provides a smoother, more youthful transition between the lower eyelid and cheek. Fat removal alone is still valid but should be done cautiously to avoid the skeletonized look.

Fat transfer is excellent for volume restoration, especially when performed by experienced hands, but is less precise than repositioning during surgery and less predictable than fillers for minor corrections.

🩺 Final Thoughts

For the most natural, long-lasting results:

• Fat repositioning is often the best surgical option for balanced under-eye rejuvenation.

• It may be combined with skin tightening or laser resurfacing for comprehensive results.

• Patients with complex anatomy may benefit from a hybrid approach, tailored to their unique needs.

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Consultation with Dr Thiagarajah

 is key. A detailed evaluation, including skin elasticity, fat prolapse, orbital rim anatomy, and patient goals, will determine the optimal technique.

Would you like a visual guide comparing these options or a sample consultation script?