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Long-term 3-Dimensional Volume Assessment After Fat Repositioning Lower Blepharoplasty. IMPORTANCE: First reported 3-dimensional quantitative study of the lower periorbital area after lower blepharoplasty using the fat repositioning technique. OBJECTIVE: To determine the volumetric effects lower blepharoplasty with fat repositioning provides to the tear trough and deep fat compartments of the upper cheek. DESIGN, SETTING, AND PARTICIPANTS: A retrospective electronic medical chart review (16-month study with a minimum of 10-month postoperative evaluation) was performed on 12 initial patients recruited to a private practice; 2 patients were lost to long-term follow-up. Patients were recruited between May 2014 and November 2014. To fulfill recruitment criteria, patients must have undergone a lower blepharoplasty performed using the fat repositioning technique with a minimum of 10 months follow-up. Patients who had undergone additional procedures or had a history of filler to the tear trough or cheek area before or during the study period were excluded. MAIN OUTCOMES AND MEASURES: Volume (mL) measurement of a defined anatomical area in postoperative patients. RESULTS: Overall, 10 patients (mean [range] age, 56 [37-66] years) who had undergone a lower blepharoplasty performed using the fat repositioning technique had volume gain in the areas evaluated. The mean (range) follow-up time was 12 (10-16) months. The average volume gain was 0.64 mL (left side, 0.61 mL; right side, 0.67 mL). There was no statistical difference when the 2 sides were compared (P = .49). CONCLUSIONS AND RELEVANCE: The fat repositioning technique in lower blepharoplasty improves pseudofat herniation while simultaneously adding volume to the lower periorbital and cheek areas. The results are reproducible with long-term aesthetic improvement in the tear trough and upper cheek areas. LEVEL OF EVIDENCE: 4.