Will fat grafting work to fill my tear troughs? Also what to do about loose skin under the eye?
Can I Use my Own Fat to Fill my Tear Troughs?
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Fat Grafting for Tear Trough Area
A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.
As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.
Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.
Structural Fat Grafting of the Lower Lid
As mentioned above, it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.
In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.
In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.
You can use your own fat, but this often times is not the smoothest appearance. Thank you for your question and good luck with everything.
Can I use my own fat to fill in tear troughs?
Yes, you can have your own fat transplanted and injected into the tear troughs but the real question is should you? No matter what you hear or read fat transfer has not been proven as reliable and predictible as soft tissue fillers and as such are prone to uneven dissolution, lumps and bumps. Perhaps in the future fat can become as predictible as the soft tissue fillers but that day is not here.
IMHO, in the thin lower eyelid skin fat lumps and bumps are far more visible than they are in the deeper tissues of the face and you would be better off trying a filler like Restylane or Juvederm to fill in the tear troughs.
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Fillers Work Best for Tear Troughs
While autologous fat can certainly be used for filling the delicate tear trough area, I would be reluctant to use it. For one thing, retrieving the fat for use in this way is a two procedure method. Fat must be withdrawn under local anesthesia from an an area, such as the thigh, abdomen or buttocks (procedure #1), processed, and then reinjected into the tear troughs (procedure #2).
Since the true longevity of transplanted fat grafts is still a subject of some dispute, and since often fillers placed in the tear trough area--where there is relatively little movement that can contribute to mechanical breakdown-- fillers injected into that region often maintain correction for well over a year, if not several years. (Anectdotally, I treated my own tear troughs six years ago as a birthday gift to myself and still do not need any re-treatment).
I have more than twenty years of experience in treating tear troughs with all kinds of materials, including Zyderm and Evolence. Because hyaluronic acid fillers, such as Juvederm Ultra XC, can be injected smoothly into this region in microdroplets, and may be quickly, easily, and completely dissolved afterward with an enzyme, hyaluronidase if so desired, I prefer this to far less forgiving materials, such as fat or permanent fillers, like Artefill.
Lower eyelid tear trough filling
Can you use your own fat to fill your tear troughs? Yes. Without more information or pictures however, I cannot tell you if that's what you need. I often prefer using a soft tissue filler such as Restylane or Juvederm as the results are more predictable (fat is one of the first "fillers" that surgeons tried- dating back to the turn of the previous century, and we still have not perfected it). Plus, if you don't like the results, the Restylane or Juvederm will dissolve, whereas fat may not. If my patients are happy with the filler results, and they want something more permanent, I'll reach for a cheek implant specifically made for that area. The results are natural, outstanding, long-lasting, and can be removed if ever you don't want it there. Regarding the loose skin- that also depends on how loose, and what the underlying muscle/fat/skeletal anatomy is like- most often a blepharoplasty is needed, someties just a simple chemical/laser peel will do, or just restoring the volume with filler or implant is enough to reduce the skin laxity.
Several options for Tear Trough correction
There will be a variety of opinions as to the best option for tear trough correction.
My personal favorites are hyaluronic acid fillers (such as Restylane or Juvederm) or fat transposition blepharoplasty.
With hyaluronic acid fillers, the main downside is that the result is not permanent. In fat transposition, fat from the orbit underneath the eyeball is draped over the bony rim of the orbit into the tear trough. The improvement tends to be permanent. Not all patients will have enough orbital fat prolapsing to allow fat transposition to be a great option. Some surgeons have had great results with transfer of a patient's fat (harvested from another area) into this area (fat transfer), but others have become much less enthusiastic for the technique in the lower lids after facing challenging complications which are difficult to correct.
If you do elect fat transfer for the tear troughs, be sure to choose a surgeon with a great deal of experience with using the technique for this particular purpose.
Mark Lucarelli, MD, FACS
Fat grafting the tear trough
Fat grafting is commonly used in the face to fill areas or depressions. I will say that using fat in the tear troughs can be quite difficult because the tissues are so thin. This area at least in my opinion may be better suited for the smaller particle HA's like restylane.
We do less fat injection in tear trough now because Restylane works so well.
Well done fat injections work great, but it is surgery. Restylane takes twenty minutes in the office with a little local anesthesia, and lasts at least two years.
Most people don't have a lot of loose skin in the lower lids. If you do, that can be corrected easily.
A well-performed Injectable Filler treatment may be used to improve your tear trough.
In my practice, lower eyelid grooves (tear troughs) are managed with Injectable Fillers. My personal preference is to use Silikon-1000, an off-label filler for permanent results. You should make sure your physician is skilled in the delicate art of filling lower eyelid skin as this area is not forgiving.
Lower eyelid wrinkles are a difficult problem, and a pinch-blepharoplasty is considered as a last resort in select patients.
I hope this is helpful for you.
Fat grafting the tear trough
Opinion will vary, however we feel that fat grafting is the best for the lower lid tear trough. It must be placed with care deeply along the trough and above. The correction is permanent and will not require repeat injections until further aging of course. Often we will use fat alone for lid rejuvenation though the skin excess must be corrected by lid surgery.
Best of luck,
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