Hello, I need advice on Coleman fat transfer for the hollow area underneath the eyelids. I am concerned with what can happen to injected fat that doesn't "take". For example, some opinions on this site report that dead liquid fat, non viable fatty cysts (walled off dead cells), and chronic inflammation are all likely to occur. What eventually happens to all of the above elements? Also, is it wrong to assume that only live cells remain after 6 months? thanks for your help!
What Are The Possible Negative Side Effects Of Fat Transfers Under The Eyes.
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Avoiding negative side effects of fat grafting under the eyes
With the transfer of any living material, whether it is fat grafting or the grafting of solid tissue like dermis/fat or fascia/fat, it is intended that some of the transferred material gets revascularized and survives. The majority of the transferred living tissue that does not get revascularized is broken down by the body's natural scavenger cell system. Meticulous surgical technique, patience and attention to detail are required on the part of the surgeon to maximize the proportion of the grafted tissue that persists as living tissue, regardless of what type of tissue the surgeon is transferring. I have seen no cases of palpable oil cysts or chronic inflammation in any patient for whom I have performed structural fat grafting, and have had no cases of postoperative infection.
As with any cosmetic surgery, meticulous technique and attention to detail on the part of the surgeon can produce beautiful, natural-appearing results - whether it's a facelift or fat grafting or a breast augmentation. In the right hands, structural fat grafting of the lower lid / cheek junction can produce a natural-appearing, and youthful contour. In inexperienced or impatient hands the result can be lumpy and even disfiguring. So make sure that the surgeon you are seeing is board-certified, has a lot of experience with fat grafting, and can show you photographic examples of the surgery in which you are interested.
The lower lid / cheek junction is a challenging area, as the skin is thin and the orbital rim (bone) is immediately below. So there is less margin for error compared to thicker soft tissue areas like the cheeks and jawline. It is certainly not an area for a surgeon to start with if he/she is just learning fat grafting surgery. With lower lids a surgeon cannot afford to 'overdo' it, for if you overfill this area (because you expect that some of the fat will not persist) you may be left with excessive fatty fullness if most or all of the fat survives. So when treating this area I feel it is critical to add fat up to the point where the contour looks ideal, then stop. If most of the fat survives, great; if it does not then you come back 3 to 4 months later and add some more (by 3-4 months any non-vascularized fat has been reabsorbed). I let all patients having lower lid / cheek fat grafting know that there is a pretty good chance that they will need/want a secondary fat grafting procedure to enhance the result in this area. I have never regretted taking a cautious and conservative approach with this area.
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Fat transfer to treat under eye hollows
You have received very different answers to your questions. I am not thrilled with the results of fat transfer in this area as lumps post treatment occur not infrequently. But I am also not thrilled with the results of Juvederm injections either as this may cause additional inflammation and swelling and look worse than the problem did initially. I think think Silikon 1000 is my favorite filler in this application and/or conservative surgery may be indicated.
Fat grafts for lower eyelids
Fat grafts are best done below the muscle because they may appear as lumpy deposits if injected right under the thin skin of the lower eyelid. the tear trough is an excellent place to inject fat grafts. There is a concern of injecting fat between the eyelash margin and the tear trough as there is no bony wall above which the fat can be injected under the muscle and there could be undesired spread of fat in this plane. See an experienced plastic surgeon or oculoplastic surgeon.
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Fat Transfers Under the Eyes
The complications you describe with fat transfer to the lower eyelids are rare when this is done by experienced surgeons. Orbital fat repositioning can also be used to fill in the grooves of the lower lid margins. If fillers are used, I prefer Restylane.
Fat transfer for the eyes.
The best way to fill the groove of the lower eyelid is not with that type of fat transfer since it is very easy to get lumps with scar tissue. If you have bags the fat can be removed from the mountain and placed in the groove and sutured. Otherwise you would be safer with Juviderm as a filler.
Problems after Fat Grafting for Tear Troughs and Cheeks
Facial fat transfer is a great option to improve the under-eye hollows. Normal aspects after fat injection include absorption of fat that does not "take". There is never 100% take and the excess, non-viable fat will simply be absorbed over time. Cysts have been described but we have not seen them in the lower eyes; likely because of the delicate micro-droplet technique used.
Chronic inflammation? This is highly unlikely because it is your own body's fat (a.k.a. autologous fat).
In terms of longevity, whatever is there after 6 months should be there after 1 year - more or less... (Yes, is some patients even a little more). Good luck!
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.