Role of Fat Grafting in Correcting Post–Lower Eyelid Blepharoplasty Hollowing

Under-eye fat repositioning—often referred to as fat grafting or fat transfer in lower eyelid surgery—is a refined technique used during blepharoplasty to simultaneously address two common age-related concerns: lower eyelid bags and the adjacent tear trough hollowing. Rather than simply excising excess orbital fat, surgeons carefully mobilize and reposition this tissue to fill the concave depression that runs from the inner corner of the eye down toward the cheek—the so-called “tear trough.” This strategic redistribution helps restore a smoother, more youthful transition between the lower lid and midface.

The procedure leverages autologous fat—harvested from the patient’s own body, typically via gentle liposuction from the abdomen or thighs—to minimize immunogenic risk and enhance long-term viability. Once processed to remove blood, oil, and fibrous debris, the purified fat is micro-injected into the tear trough region using ultra-fine cannulas. Precise placement is critical: overcorrection can lead to visible fullness or a “puffy” appearance, while undercorrection may fail to camouflage the underlying orbital rim, leaving residual shadowing.

Clinically, successful fat repositioning yields dual aesthetic benefits: it reduces the prominence of lower eyelid fat herniation (the “bags”) while concurrently softening the contour discrepancy between the eyelid and cheek. Unlike temporary fillers, repositioned fat—when adequately vascularized—can provide durable, natural-looking correction. However, outcomes depend heavily on surgical expertise, patient anatomy, and postoperative healing; approximately 30–50% of transferred fat may undergo partial resorption within the first six months.

This approach represents a paradigm shift from traditional resection-only blepharoplasty, emphasizing volume restoration over mere tissue removal. It is particularly well-suited for patients with concurrent volume loss and mild-to-moderate fat prolapse, and is increasingly integrated into comprehensive periorbital rejuvenation strategies.