I had a fat transfer under my eyes because they were so hollow. Around 6 months later, there was an uneven swelling that hardened into uneven lumps. It made me look like I had pouches. So I went back to the surgeon who suggested that the best correction to resolve this was to perform a full blepharoplasty. This was 2 days ago and am panicking about what I have done to myself. Was this a bad choice? What options do I have for correcting this?
Correct Bad Fat Transfer Results with Blepharoplasty?
Doctor Answers (12)
If your surgery was six months ago and things have reached a plateau, it is likely that you have a stable problem. The problem is how to treat it.
Firm lumpiness from fat injection to the lower eyelids is a common problem. In my experience it is usually necessary to remove the fat injection lumps directly. This is a tricky proposition, to say the least, because the lumps can be in all layers of the lower eyelid, from the epiperiosteal layer to the shallow subcutaneous layer, with the orbital septum and the orbicularis muscle in the middle.
Often, correction of the problem will involve midface elevation through a cheeklift, canthal restoration to support the amount of work to be done on the different layers, direct removal of fibrous fat injection tissues, possibly placement of new grafts. In our practice we typically use nontraumatized autologous fat fascial grafts (LiveFill) placed precisely, usually in the eye-cheek junction or the tear trough region. Or sometimes lumpy fat injection grafts can be removed directly through a transconjunctival approach or directly through the skin through tiny incisions, it all depends.
A traditional blepharoplasty usually involves reduction in fat from the lower eyelid, which would not typically deal with the fat injection lumps.
Your case underscores two points. First is that the lower eyelid is an unforgiving anatomic area. Second is that patients should have great caution before undergoing even seemingly minor procedures such as fat injection to the lower eyelid.
It never hurts to seek several opinions from plastic surgeons with special interest in the midface (i.e. cheeklifts, revision lower blepharoplasty) before proceeding with this next very critical step.
You may need to look at other options.
I think Dr. Wallach thought your surgery was two days previous and if that were the case I completely agree with his assessment. However, if you had fat transfer 6 months ago then you may have issues with the fat not surviving or scar tissue forming where the fat transfer was attempted.
The lower lid and area below the lids is one of the more delicate places on your body and small amount of tissue can make a big difference. When I was in training at Yale University, we had a professor who had spent considerable time analyzing this area and the best way to restore a "hollowed out" look. He correctly concluded that in lower lid blephs when people remove fat, it tends to make people look more gaunt and that the problem is that fat in that area has descended and can be restored by positioning it at a level consistent with its position when you were younger.
The difference between fat transfer and this technique is you're not devascularizing (cutting of the blood supply) to the fat you're moving so it is more reliable and produces a more predictable result (critical in an area where the skin is so thin). In addition - you may have needed a procedure to tighten the skin of your lower lids to begin with and it is possible the fat transfer has emphasized this need. It is difficult to suggest specifically what you should do without a close examination but at 6 months out I think it is likely that you should consider a revision to improve the look of the lower lids.
I hope this helps.
Steven Williams, MD
Blepharoplasty after Fat grafting
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There are other ways to help this issue
Lumps and Bumps can happen without almost anything that you do when you manipulate the tissues. When they are around the eyes, it's pretty hard to mask their appearance. I can appreciate the concerns. There are many things that can be done to help this.
First, steroid injections can help by causing some of the fat to be dissolved by the body through the action of the steroids. There are risks with the use of steroids so you should be aware of these before undergoing these injections. This course may take several injections, and it may take a couple of months for the steroids to fully work.
The other option is to actually make an incision and take the fat out.
The third option is to actually carry out micro liposuction to take the fat away. Going to someone with a lot of experience with fat grafting can help avoid some of these issues, but even the best will have some lumps.
Fat grafting is a very complicated process for the surgeon and there a lot of steps that go into this procedure. Each step can affect the survival of the fat which can lead to lumps because some cells survive and some cells don't. The more reliable the process you have the better chance you will get even survival of the fat and hence a better result. Its all in the technique!
Consulting a Board Certified Facial Plastic Surgeon would be something that I recommend. We specialize in the face and are highly qualified to help you with this.
Correction of lower eyelid nodules after fat transfer
Fat transfer is a well established method of restoring volume to the face. The amount of fat survival depends on technique of harvest and injection. Technical considerations may affect volume loss, symmetry, and need for further revision.
The advice of your surgeon on the fat transfer should be heeded. Nodules arising from fat necrosis may ultimately subside or may remain permanently. If your surgeon believes they will remain permanently, the best option may be to surgically excise the lesions with a blepharoplasty type incision. Be advised that there are inherent risks associated with a surgical approach including assymetry, scar tissue, eyelid retraction, unsatisfactory results, and need for further surgery. An experienced blepharoplasty surgeon is advised.
Relax, Turn Off Your Computer, and Be Patient
Sorry to hear about your ordeal. I can imagine how scared and anxious you must be.
The most important thing for you to do now is to follow your post-operative instructions and stay in close touch with your treating surgeon. Panicking and searching the web two days after eye lid surgery will not help in your recovery at all. There is nothing to do at this point but heal as well as you can. Your surgeon should be able to tell you how he/she feels the operation went.
As you can see in the other answers here, after 6 months, blepharoplasty is a method of addressing lumps after fat transfer.
After a few months, if there is still a problem, then return to your surgeon for an answer, or if you prefer, consult with the best opthalmoplastic surgeon that you can find.
Try to relax, turn off the computer, and be patient. I hope that all goes well and that you heal beautifully. Be well.
Hang in there
It is difficult to fill in the area under the eyes. Many people choose to have fat injected in the hollows under the eyelids. This is appealing because it has the chance of being a "permanent" correction. The problem is that fat is living tissue. In order for it to last it needs a good blood supply. That usually is not a problem around the eyes. However if any portion of fat does not stay completely healthy, with a good blood supply, it either shrinks or becomes firm. If that happens in any of the fat under your eyes you can see lumps and bumps. This is because the eyelids are very thin and the tissues "telegraph" through the thin eyelid skin.
If you had bumps after 6 months, it was reasonable to have them removed, through a blepharoplasty type operation. At this point you should wait about 3 months before you make any decisions about the quality of the results. If there is still some irregularities in the contour of your eyelids, these could then be treated with Restylane which has the advantage of being adjustable if there are any problems in the future.
Correct bad transfer results with blepharoplasty
Yes. This is an option for you. It will require marking of the fat lumps and tedious dissection and patience by your surgeon. There is no right time to do this but at 6 months, I think you have been sufficiently patient for improvement. I would seek out an oculofacial surgeon listed by ASOPRS.
Web reference: http://www.kassmd.com
2 days is not enough to evaluate any surgery
At this point, I would wait. 2 days after any surgery is not a good time to evaluate the results, especially with blepharoplasty surgery. From what you describe, it sounds like you had appropriate treatments. I would wait at least a month, and sometimes several months, before determining the success or failure of the treatment.
Wait it out
The firmness from after the fat injections to the lower lids was the fat that was injected. The skin of the lower lids is very thin and unfortunately, sometimes the grafts become palpable. I can't answer you about whether or not you made a mistake to have undergone bleph 2 days ago, because I don't know what you started out needing. Now, all you can do is wait it out and heal and see how things turn out.
Steven Wallach, MD
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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