Question: I’ve seen some results of fat transfer that look great but other times the person looks too puffy or bloated. How do you avoid a puffy look?

Answer: The simplest way to avoid a puffy or bloated look with fat grafting is to simply not put in too much fat.  My personal opinion is that there is a "happy place" for fat grafting where we get to add a small amount of volume and make somebody look refreshed, and yet we do not need to add so much volume that they look puffy or swollen.  I will most commonly perform fat grafting in association with other surgical procedures, such as lower lid blepharoplasties and facelifts, and I, therefore, typically place relatively small amounts of fat compared with surgeons that try to rejuvenate the entire face simply by adding volume with fat grafting.  I have found that this combination approach allows me to create extreme rejuvenation while maintaining a very natural and healthy appearance. 

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Question: I am a 39-year-old male and have very heavy, full eyelids as does my mother and several of her relatives.  I would like to have a Blepharoplasty performed.  I was wondering if I should wait until I am a bit older to get more bang for my buck in later years or does it make a difference?

Answer: I would have to personally examine you and evaluate your particular anatomy, but I am always recommending that patients consider surgical intervention at the first signs of concerning area simply because you will have a longer period of time where you can enjoy the result.  It would be very uncommon for heaviness and excess skin to recur after a blepharoplasty to the point where you would consider having another blepharoplasty in the future.  I, therefore, recommend going ahead and having the procedure done now assuming that you have a considerable amount of excess skin and soft tissue in the upper eyelids.  Since this is a permanent fix, you will essentially have an improvement for the rest of your life.

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Question: Can I have my own fat injected into the area under my eye? I have very dark circles and would like to know if this would help.

Answer: Yes, I commonly perform fat transfer and fat injection into the infraorbital area, or area under your eye, in an attempt to fill the area where we tend to lose volume over time as we age. I will most frequently perform this in conjunction with a lower eyelid blepharoplasty that is performed through the pink part of the eye on the inside of the eyelid. This allows me to remove the excess fat that is herniating and creating the bulge but then allows me to fill the depression, or dark circle, beneath this area with the fat transfer.

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Question: I am a 39-year-old female who has a slightly more relaxed looking (droopy) left eyelid. Would getting a Botox injection near my other eyelid relax that area and thus make my eyes appear more balanced?

Answer: Yes, Botox could actually be used to temporarily drop the higher eyelid to match the droopy eyelid. But, more importantly, I think you need an evaluation to determine exactly what the cause of the droopy eyelid is. If it appears to be related to the separation of the muscle from the eyelid itself causing the droopiness then the Botox could certainly be a temporary solution. But, I would want to make sure there was nothing more serious going on prior to treating this area with Botox. And ultimately, I would discuss a more permanent treatment option with you, which is a relatively simple outpatient surgery to reattach the tendon to the upper eyelids so that the eyelid is the same height and the opposite unaffected eye. This is a relatively complicated issue and really requires a thorough evaluation for proper diagnosis and management.

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Question: I am a 42-year-old mom of three. I do not feel old, yet I feel like I constantly look exhausted. Does blepharoplasty help reduce darkness under the eyes?

Answer: There are several reasons for darkness under the eyes, but a blepharoplasty certainly can improve the darkness created by shadowing due to the bulge that tends to appear in the lower eyelids during aging. Ultimately, a thorough evaluation would be performed so that we can assess the reason for your dark circles and then come up with a customized treatment plan to correct your specific problems. In most circumstances that would include a lower lid blepharoplasty.

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