I had lower and upper eyelid surgery done 3 1/2 months ago. My doctor removed too much fat and I have sunken hollow eyes. I also have ectropion in one eye along with chemosis. I will have a second surgery soon by another doctor, and he will be putting fat into the hollow places. He says that by fixing the ectropion, it will heal the chemosis. I want to know, how long will the new fat last? I heard that it goes away in 6 months. But the doctor said if, it is done right, it will last a very, very long time. Is this true?
Longevity of Fat Replacement After Eyelid Surgery?
Doctor Answers (9)
Fat grafting can provide long lasting results
Fat grafting is a very accepted technique for a variety of cosmetic and reconstructive procedures. Since the fat is your own tissue, it is not rejected. However, there is always some degree of uncertainty as to how much of the fat will "take" and how much will resorb. There is also a risk of lumpiness, and the eyelids are one of the more challenging areas in this regard.
Other options include fillers such as Juvederm which can provide improvement for about a year, but, again, beware of lumpiness. Another option would be to perform a cheek lift and canthopexy (for both sides), which could help correct the sunken appearance and the ectropion. If you are not symptomatic, I would advise more healing time before any of the above!
Eyelid fat replacement after eyelid surgery
"I had lower and upper eyelid surgery done 3 1/2 months ago. My doctor removed too much fat and I have sunken hollow eyes. I also have ectropion in one eye along with chemosis..." - I am truly sorry to hear of your predicament but it sounds to me like you are rushing head long into another complication. For the absolute best revision results all traces of inflammation must be gone and the eyelid tissue must be supple. Operating before 5-6 months have passed invites miscalculation and further and worse complications.
An ectropion is the eversion and loss of contact of the rim of the lower lid with the eyeball. It can be caused by multiple processes or combination of processes such as tissue weakness (INVOLUTIONAL), scar tissue (surgery, injury, burn, lasers- CICATRICIAL) and, or by eyelid muscle paralysis. In your case, it is probably due to either one or all three of these processes. IF the chemosis is caused by the process(es) causing the ectropion, repair of the ectropion should also correct the chemosis.
Fat grafting of the eyelids in the best of hands is a 50-50 proposition. When fat is placed in the lower lids and is not quickly supported and nourished by a blood supply, the fat dies leading to palpable nodules and reappearance of the hollowed look supplemented by a bunch of bumps. No one way of treating fat and grafting the fat has completely solved this problem. So - it is hard to say how long the fat will live except to say that if it does live, it will remain alive for years. The challenge is in getting all or most of the fat to survive.
Fat for Hollow Eyes
The fat that the first surgeon removed is located within the orbit, around the eyeball or globe. I honestly have never heard of anyone replacing this fat. First, for fat to survive it must get blood supply. So when fat grafting is done the smaller the transferred product the better. For instance I use 1.2mm cannulas to inject fat (smaller than most use). When injecting this into the face the blood supply comes from the surrounding skin and muscles.
Injecting fat into the orbit poses significant risks. First, if any of the orbital veins are breached fat could get into it resulting in a fat embolism leading to possible blindness. Second, if the fat doesn't get get blood supply it will either necrosis, turn hard, or just get reabsorbed.
Injecting fat under the skin can pose the same risks and may not solve the problem.
I would strongly recommend seeing several surgeons before proceeding. Get many opinions first. Remember it's not just the cosmetic issue at hand it's also your vision.
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I would be careful being treated so soon after the initial eyelid surgery
Unfortunately, this can occur with over enthusiastic eyelid surgery. While there is not an exact best time to correct surgery, unless there is an ocular emergency related to drying of the eye, it is generally best to wait a minimum of 6 months before carrying out corrective surgery. Especially if you still have chemosis, this is evidence of persistent swelling after the surgery. This would cause a surgeon to underestimate the amount of fat grafting potentially leading to an unsatisfactory reconstructive procedure. Also many post eyelid surgery conditions of the lower eyelid are diagnosised as ectropion when they are is in fact vertical and or horizontal inadequacy of the lower eyelid.
I would carefully look at the credentials of the potential doctor and make sure they are a fellowship trained eye plastic surgery and a fellow of the American Society for Ophthalmic Plastic and Reconstructive Surgery and not just an ophthalmologist, facial plastic surgeon or general plastic surgeon. You can look on the ASOPRS website (www.asoprs.org) and look of the surgeon if your are not sure. Also before you rush into surgery, you might get additonal opinions regarding your best options.
Longevity of fat graft injections
The ectropion is certainly causing the chemosis and needs to be addressed. Fat grafting to the eyelids can be done; however, the rate of fat resorption varies significantly making results inconsistent. After two months when the injected fat graft has healed, what remains is permanent.
Fat replacement does work but fillers do too
Replacement of eyelid fat with corrective eyelid surgery is a standard oculoplastic surgical technique. In the hands of a skilled oculoplastic surgeon, it is a straight forward, quite routine, and well accepted technique. In general the fat tends to last months to years, perhaps longer. Whether or not, the fat cells survive is questionable, but the healing process as the fat would slowly resorb still leaves good volume replacement. Some of the fillers also work very well for this problem
I would encourage you to follow the corrective steps outlined by your surgeon and wish you all of the luck.
Fat in lower lids
Adding fat to the lower lids to fill out the hollowness may or may not be a permanent thing. Some of the fat may likely resorb. Dealing with an ectropion is hard enough.
Correction of Hollow eyes and ectropion
Typically, it is best to wait at least six months before repairing an ectropion unless you are symptomatic such as dry watery eyes. Chemosis will generally resolve before the need for an ectropion repair and often it causes a temporary ectropion until it resolves so I would advise waiting on the ectropion repair but without pictures it would be hard to say otherwise. Also, you should have been prescribed by your physician eye massage techniques to help with the chemosis. As far as fat replacement for excessive orbital fat removal, sometimes it lasts many years and sometimes multiple injections are required. Use of the micro-augmentation technique has a little better results but typically fat take is no better than 50% which may or may not be enough to correct your problem. I hope this information helps
Fat injections can provide permanent correction for hollow lower eyelids.
Your doctor is right. Fat injections can provide very long lasting correction for the tear trough deformity and for post surgical hollows of the lower eyelids.
With good technique, about 80% of the fat should last. The result you see at 4 months should be the final result.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.