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What is the best option for a lower bleph, Fat repositioning or a fat transfer option? What about mid face/cheek lift?

Question posted by The Shoe Fairy from Toronto

I am 50 years old with slight bulg and hollowing, looking for best treatment options for long term results

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One thought on “What is the best option for a lower bleph, Fat repositioning or a fat transfer option? What about mid face/cheek lift?

  • Dear The Shoe Fairy,

    Thank you for your excellent clinical question and cosmetic list post.  Lower lid aging is characterized by many features including the appearance of horizontal fine lines and wrinkles, lower lid fat pads or bags, hollowing in the infra orbital area and descent of the cheek with elongation of the lid cheek junction.  Any one or combination of these features may be present in addition to brown discoloured skin or venous engorgement.  Therapeutic intervention depends on the number of factors that have contributed to the aging lower lid.  Lower lid treatment such as soft tissue fillers camouflaging the lower lid bag or topical colour correction lasers for the venous engorgement or fractional lasers for fine lines can be very good early options for lower lid aging.  These non-invasive filler and laser options can be combined with Botox to minimize enlargement of the lower lid and muscle and bulging in selective patients to provide non-surgical lid rejuvenation.
    Surgical correction of the lower lid often requires a combination of judicious fat pad removal or fat pad transposition into the empty and hollow tear trough below it or a combination of fat pad reduction and fat grafting to the infra orbital buttress and tear trough using fat from another site that is spun down, prepared and injected.

    If there is an increased lid cheek junction and descent of the malar fat pad, elevation of the mid face through endoscopic mid face techniques or other repositioning techniques can bring the malar fat pad closer to the lower lid and reduce the appearance of the lower lid fat pad which can be also modified at the time of the mid face lift.

    So, as you can see the lower lid can be quite a complex diagnostic process and visiting with a cosmetic plastic surgeon with expertise in this area would be paramount.  Seek out the opinion of two or three plastic surgeons with a significant experience in lower lid and mid face techniques.  Request before and afters, possibly speak to patients that had this done and you should
    anticipate a high probability of an excellent aesthetic outcome.

    I hope this information has been of some assistance and best of luck.

    For more information, please review our blepharoplasty page.

    If you’d like to schedule a consultation please call SpaMedica at (416) 922-2868 or visit us at our website at and fill out an e-mail online consultation request form.

    R. Stephen Mulholland, M.D.

    Certified Plastic Surgeon

    Yorkville, Toronto

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