Can Eye Bags from Fat Transfer Be Corrected Through Blepharoplasty?

I am 25 years old and I have had fat injections under my eyes about 3 months ago. I had hollowness and dark circles around my eyes, and my plastic surgeon suggested a fat injection. However, I found that the fat has lumped and the dark circles are still visible. It now looks like a have bags under my eyes. I'm really not happy with the results of the procedure and I want to know if it can be corrected by transconjuctival blepharoplasty. However, I don't want all the fat to be taken out because I have found that my eyes aren't as dry as they used to be before the fat transfer.

I am really worried about the bags under my eyes. It makes me look tired and I am really conscious about it. Please give me some advice. Thank you.

Doctor Answers (18)

You will benefit with a personal consultation with an eye plastic surgeon

+3

Dear Tuscany,

Fat transfer can be a fantastic procedure. However, it is very difficult to use in the lower eye lid due to lack of soft tissue coverage. In the cheek or other parts of the face, transfered fat is hidden by the subcutaneous fat. In the lower eyelid, there is essentially no lower eyelid fat. Transfered fat can easily form lumps that present as irregular fullness in the lower eyelid.

The situation you are experiencing may or may not benefit from transconjunctival lower blepharoplasty. One problem that I often encounter when trying to correct a lower eyelid fat transfer ( Its worth emphasizing that these are individuals who have had surgery else where and then seek me out for help.) is that the lumps of fat are not in just one place. Lower eyelid fat creating fullness lives behind the orbital septum and it is always in the same anatomic locations. Transfered fat sits in numerous planes. Its removal is therefore anything but straight forward. Occasionally I will use restylane to fill around the existing lumps of fat.

I would encourage you to consider a consultation with an eye plastic surgeon to assess your situation. I would be very careful regarding the proposed plan for surgical revision. Also, steroid injections are not very predictable but occasionally these can be used to atrophy some of the grafted fat. Good luck with your issue.


Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

Fat injections are excellent for filling eye area, if done well

+3

Dear Tuscany,

Well-placed fat injections are an excellent source of filler for the area around the eyes. If done well, it should not be overfilled - but filled to look good at the moment that injections are performed. The one problem with this technique is that some of the fat is dead and will go away in 3-6 months and you may appear less filled than desired. This can be rectified with additional filler.

Other fillers do not provide enough volume for the area around the eyes and will make dark circles under the eye look even darker - the tyndall effect. A new process called the Viafill System will be released in May and will provide more live cells for injection. This will reduce the loss of fat. In your case it sounds that the fat was injected with a cannula that is too large or was overfilled. In either case, you should wait and hope that most of the fat dissolves over the next 3 months.

Robert M. Freund, MD
New York Plastic Surgeon
4.5 out of 5 stars 18 reviews

Infra Orbital Fat Transfer Correction

+2

Tuscany

Regarding the dark circles - filling the depressions under the eyes does not normally correct these circles unless they are created by shadows.

Regarding the bags - The most important information needed to correct your problem (under eye bags and lumps) is to determine exactly where the fat was injected. If the fat was injected into the sub-dermal or SOOF spaces a transconjunctival blepharoplasty would not be the best approach. If the fat was injected below the orbital septum, then a transconjunctival approach would work fine. If the injections were in both in front of and behind the orbital septum, I would prefer the sub-ciliary incision allowing easier access to all spaces.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 9 reviews

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Fat transfer lumps under the eyes can be corrected with transconjunctival blepharoplasty

+2

Tuscany,

Yours is a common problem following fat injection to correct dark circles under the eyes.

I would wait another 2-3 months for the fat to be less prominent and would recommend massage of the lumps to hopefully improve the appearance.

I use a transconjunctival laser incision on the inside of the lower eyelid in the pink part-the conjunctiva.

This avoids an external scar and incision which can cause sagging of the eyelid, which could worsen your dry eye.

This is a very tricky operation. Hopefully the fat was injected in a uniform plane beneath the muscle so that it will be easily accessable.

If the fat is in the wrong place-too low beneath the eyelid it will have to be removed-hopefully the fat can be replaced in the hollow, but if not a composite graft can be taken from around your belly button and grafted into the correct location.

Ipl treatments can lighten the color of the skin in the dark circle.

Find an expert plastic surgeon whyo specializes in eyelid surgery-this procedure is not for the faint of heart.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 34 reviews

Lumpiness after fat injection

+2

Lumpiness after fat injection can occur at a different anatomic place than fat reached by blepharoplasty, so the method of removal will depend on exactly where the fat is. While it is possible a blepharoplasty might correct the problem, it is also possible that the fat is located below the skin, underneath the muscle and not the usual place of below the orbital septum.

The skill level for treating this problem is much greater than for a typical transconjunctival blepharoplasty.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 94 reviews

Maybe, but depends on how lumpy the eyelids are

+2

This could be very complex. Lumps from fat injections may have to be cut out to get a smooth result. It probably can't be done by transconjunctibal approach, although it might be possible. I would have to see it to determine the best treatment. If you see someone, make sure they are highly qualified, and don't go to the one that injected the fat into your eyelids.

E. Anthony Musarra II, MD
Atlanta Plastic Surgeon
4.0 out of 5 stars 9 reviews

Correcting eye bags from fat transfer to the lower eyelids

+1

There are several ways to correct excess fat in the lower eyelids after fat grafting in this area. Your surgeon may elect to remove these fat bags through a blepharoplasty if they are of significant size. Your surgeon may also elect to perform a small excision and remove this fat directly. If the bags are of minimal size, it may be possible to inject the medication into this fatty area to encourage it to melt away on its own.
 

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 66 reviews

Bags after fat grafting

+1

 

Your bags may be festoons (swelling of the upper cheeks) which can sometimes occur after fat injections.  This is typically temporary and can sometimes respond to dilute steroid injections.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 141 reviews

Bags under the eyes at the age of 25

+1

The bags under the eyes at age of 25 are probably more related to allergies and/or hereditary pigmentation issues. As there is very little fat present in the lower eyelids at this age, it is very difficult to remove any fat that has been placed in the orbital sockets completely. Bags underneath the eyelids are all caused by fat in three little compartments that can be teased out through a transconjunctival approach if they are causing a noticeable cosmetic bulge.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Bags after fat injections

+1

Tough question. It is hard to tell without examining you. But, some of the bags you are complaining about may be residual swelling. If you have lumps from the fat injections, you might want to remove the fat directly through very small incisions on the lower lid. Dark circles are usually either shadows or due to the visualization of the muscle through the thin skin. Some have tried hydroquinone to bleach the skin, but most of the time that doesn't work especially if it is from the muscle.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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.