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Fat Grafting with Local Anesthesia - Tear Trough Area

I'll have fatgrafting in tear through. Surgeon will not inject anesthetize liquid in area where fat will be put as this area would then be swollen from liquid - so would make it hard to see where he is placing the fat. He will only anesthetize area below the tear through, insert needle there and let it pass under the skin to arrive to where to put the fat in tear through. He said it will not hurt much. Is this true and is this a normal anesthesia method for fatgrafting in this area?

Doctor Answers (7)

Nerve block to lower eyelid.

+1

The nerves that pass up into the lower eyelid come from a hole in the cheek bone (infraorbital foramen) which are typically blocked through the skin or via the mouth,  

Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

Would not use fat for tear trough

+1

The area can be anesthetized with numbing cream, blocks etc.  The bigger question is why use fat for an isolated tear trough deformity.  If you are having another case, i.e. liposuction, tummy tuck, face lift, etc, it makes sense to harvest fat and use it as an implant.  The fractional additional time is minimal.  However, if all you want is your tear trough filled, I would go for a hyaluronic acid filler,.  It is cheaper, more reliable, and results are more consistent.  If you think that the fat will be permanent...not so.  Everyone will tell you that there is a CHANCE that the fat will linger on.  However, no one can predict what percentage of the fat if any will last long term.  

Houston Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Tear trough

+1

Fat transfer to the tear trough requres extreme expertise.

The fat should be harvested with a very small cannula( Some times the infiltration cannula is used to harvest the smallest size fat cells) the injected deep to the muscle. If the fat is injected in the muscle or more superficial it will cause lumpiness that is practically impossible to remove.

Pain can be minimized with infraorbital nerve block, pain meds and sedative by mouth.

Baltimore Plastic Surgeon

Fillers for tear trough

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Pain from the injections of the tear trough depend on the speed in which the product is injected, the size of the needle/cannula, the depth of penetration and the tissues in which the filler is placed. Usually fat injections are not that painful. If you're concerned, you could have your first treatment with a hyaluronic acid which can be mixed with a local anesthetic or use the ones that come prepared premixed, which may decrease the discomfort. Ice application immediately preoperatively can help you too.

Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Tricky to inject fat in the tear trough area

+1

The area of the injection can be numbed up with local anesthesia, but in my opinion fat injection of this area is very tricky and unforgiving.  You might want to consider Juvederm, or one of the other "off the shelf" fillers first, as these are also reversable.   Discuss your concerns with your surgeon, to arrive at the best choice for your particular needs, as every patient differs.

Manhattan Plastic Surgeon
5.0 out of 5 stars 13 reviews

Fat grafting with local anesthesia

+1

The doctor might be indictaing that he will be blocking the area with a local anesthetic. The block will allow to inject the area relatively painlessly. Depending on the method he uses to harvest the fat, a lot of times, it contains anesthetic material in itself. This also allows a relatively pain free procedure. Injection is usually painless along the deeper plane especially if a cannula used rather than a sharp needle. Discussing the procedure further with your surgeon should answer all your concerns and queries.

Dubai Dermatologist

Fat Grafting with Local Anesthesia - Tear Trough Area

+1

Regarding :  "Fat Grafting with Local Anesthesia - Tear Trough Area
I'll have fatgrafting in tear through. Surgeon will not inject anesthetize liquid in area where fat will be put as this area would then be swollen from liquid - so would make it hard to see where he is placing the fat. He will only anesthetize area below the tear through, insert needle there and let it pass under the skin to arrive to where to put the fat in tear through. He said it will not hurt much. Is this true and is this a normal anesthesia method for fat grafting in this area
?"

It is VERY important to see the extent and depth of the area about to be filled to avoid under - or over-filling. The easiest way to numb this area is to numb the sensory nerve that gives feeling to the lower lid, cheek, side of nose and upper lip - V2 or the Infraorbital nerve.

The vast majority of plastic surgeons can numb it painlessly with a painless injection through the mouth at the point where the nerve leaves the bone WITHOUT causing swelling. Placing a dental topical numbing fluid on the soft mouth cheek for a few minutes before the shot makes it a painless procedure.

Fat grafting around the eye needs to be done in small amounts to avoid creating lumps. This means many short passes with little amounts of fat placed each time with a total of UNDER 3 cc.

Good Luck.

Dr. Peter Aldea

Memphis Plastic Surgeon
5.0 out of 5 stars 52 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.

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