I had a transconjectival upper and lower blepharoplasthy three years ago. This left a lot of loose skin and hollowness under my eyes, and uneven upper eyelids. So : I had (6 months ago) bilateral lower skin pinch (the left side has very bad scar even 6 months later) and upper left additional blepharoplasthy to make the upper eyelids even on both sides; I also had at the same time upper and lower fat injections (3cc each) on both eyes. Now the upper eyelids do look just a little better than before, but the lower right is still hollow – 6 months today after the fat injections. The surgeon tells me to wait a year, that the fat will grow its blood vessels and it will fill the hollow part. I am very skeptical about that.. Any input will be appreciated…
Fat injections under eyes do not work so far...
Doctor Answers (6)
Fat transfer is unpredictable...I think HA fillers are better
In my 10-plus years of experience in the cosmetic field, I have never really experienced an amazing result with fat transfers. Fat transfers are less than ideal for under eye treatment for two main reasons. First, because fat will be absorbed by your body, it is unpredictable and can lead to over-correction leaving the eyes looking puffy. Secondly, because it can be lumpy. Overcorrection and lumpiness cannot be minimized after a fat transfer. Fat transfers are also extremely tedious and require a lot of prep (fat harvest) which is expensive and time consuming. I typically recommend patients try a hyaluronic acid for under the eyes. My personal recommendation is typically Restylane since it is a wonderful “filler” rather than plumper that is slowly absorbed in the skin. Restylane is a lot smoother and should there be a need to remove the filler we can simply use hyaluronidase to melt away the hyaluronic acid. Restylane will last six months minimum under the eye and is non-invasive.
Fat transfer is a process, not an event; results take time
Fat transfer, even when all goes smoothly, is more of a process than an event. The fat is initially overcorrected, and there is swelling in the tissues that makes the correction seem even more than it really is. Over time (3-6 months), the swelling wanes, the fat partially dies back due to the stress of the surgery, and results seem inadequate. Often, but not always, fat will then "bounce back" over the 6-12 month interval, as it overcomes that stress.
This roller coaster course and unpredictability is frustrating for both the patient and surgeon, but they are the nature of fat transfer. Like planting a living lawn, the process takes time, and getting even coverage may take a few seasons' worth of patching (i.e., multiple sessions of fat to achieve the fullness and evenness you desire). Once you have a nice lawn however, it lives and lasts for years.
If you would rather pursue more predictable coverage, without seasons' worth of effort, you might consider "astroturf" - injectable fillers. Like astroturf - they can be made basically perfect with one predictable go, can be reversed easily if you don't care for them, but they have a limited wear lifespan and will need to be replaced in the future.
Under eye fat transfer
Fat transfer has the potential to significantly improve lower eyelid hollows, particularly when fat is injected deeply along the bony infraorbital rim and along the cheek to create a smooth transition between the two areas. You can usually determine how much fat has survived at the 6 month mark. It is not likely that more fat will appear over time. I would consider another session of fat transfer or an injectable hyaluronic filler to the area, but of course you should consult with a surgeon that is experienced in facial fat transfer.
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Fat grafting in lower eyelid
There is a point in time that your fat will go down and reach a nadir. Usually I see that 6 months is when the fat reaches a low and then it comes up at around a year. But if you don't see any results, it may not bounce back as much as you want at 1 year. You may need to go to someone else for fat grafting for longer lasting results.
Persistent eye hallowness after fat grafting
I tell my patients to expect the fat graft healing process to take about 18 months. The postoperative swelling usually resolves over the first 6 months after which time the blood vessels will continue to grow into the new fat cells. As this occurs the fat cells should "blossom" for the next 12 months. It's hard to know how much more filling this will produce in your case, but it's certainly worth hanging in there and let your body do its healing.