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Fat Transfer for Under Eye Hollows

I've heard about a procedure where my body fat can be transferred or injected on my under eye area for dark circles and hollowness. Is this safe, and will results be permanent?

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Structural Fat Grafting Under Eyes - Look at Dozens of Photos to See Results

The ONLY treatment for hollow lower eyelids is fat grafting. A Link to my fat grafting before and after gallery is attached.Fat grafting of the lower lid area requires expertise, extensive experience and meticulous technique. As the area is covered by a very thin layer of skin and muscle, overcorrection must be absolutely avoided. My approach is to graft fat to the point that the area looks aesthetically ideal, then stop and wait 3 months to assess fat survival. As fat survival is variable, additional fat grafting procedures may be performed based on the results of the first. Take a look at the many examples of fat grafting to the upper and lower eyelids on my website (link below) When prformed expertly, fat grafting can provide very beautiful and very natural looking results.

Each passing year I find myself performing less 'invasive' lower lid surgery (i.e a formal lower blepharoplasty) and more lower lid rejuvenation by means of structural fat grafting. My before and after gallery includes some patients who have come to me for corrective surgery. See link below.  

 The reality of aggressive lower lid surgery - which involves some combination of skin excision, fat pad reduction and/or fat pad transposition, orbicularis (muscle) redraping and excision, and canthal support (to hold up the lateral aspect of the lower lid while everything heals) - can easily create an 'operated' appearance.  Every experienced blepharoplasty surgeon understands quite well that the lower lid can be very unforgiving, and that an 'operated' appearance can be produced despite the best efforts of even the most skilled hands.
Some patients absolutely require an aggressive approach to the lower lids: those with bulging fat pads, marked skin and muscle redundancy, and obvious lower lid laxity.  Many patients with mild to moderate aging changes, on the other hand, can obtain youthful and natural-appearing results by means of structural fat grafting - to fill in the tear trough, and to blend the contour at the lower lid / cheek junction.  This can be especially useful for patients with a hollow or gaunt appearance at the junction of the lower lid and cheek, and for those with poorly projecting cheekbones that provide minimal support for the lower lid.  If this area is inherently hollow, then the last thing a surgeon should do is remove fat from behind the lower lid, as doing so will only serve to aggravate the hollow appearance and will actually accelerate the apparent aging of the eye area.
Patients with full cheekbones and excellent lower lid support usually do very well with a traditional lower blepharoplasty, although if I feel that I can produce an equivalent result by means of fat grafting and a modest amount of skin excision I will certainly choose the less invasive (and quicker recovery) fat grafting option.  Patients with poorly projecting, flat cheekbones in which lower lid support is lacking, on the other hand, are at significant risk for post-blepharoplasty complications and that obvious 'operated' lower eyelid appearance.  These patients are often best served by structural fat grafting to camouflage the hollowness and create some lower lid support.
Adding fat definitely improves lower lid support, and it often reduces the amount of lower lid skin excision that is required to produce an improved lower lid appearance and a blended lower lid / cheek junction.  I frequently see patients who have previously undergone a blepharoplasty procedure in which an excessive amount of upper and/or lower lid fat has been removed, and they invariably report that since that surgery they feel that they look tired, older, and even ill.  For patients with post-blepharoplasty hollowness, the only way to restore a healthy and more youthful appearance is to restore the missing soft tissue volume, and this can reliably be accomplished by means of structural fat grafting.
Structural fat grafting is a procedure in which small amounts (less than 0.1 cc at a time) of fat are carefully introduced in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each micrograft, new blood vessels are able to grow into the grafted fat, allowing it to persist indefinitely. If this process of blood vessel ingrowth (neovascularization) does not occur, then the transferred fat cannot truly be considered a 'graft' and is instead just another temporary 'soft tissue filler' that is broken down and reabsorbed over several weeks.  Fat grafting requires specialized training and specialized surgical instruments, as well as patience and meticulous attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing aesthetic enhancements can be achieved.
Because the lower lid tissues tend to be quite thin, a conservative approach is an absolute necessity for fat grafting of this area.  If one overfills the lower lid  /cheek junction, and most of the fat persists, then the patient ends up with unnatural fullness that needs to be corrected.  I tell patients that our plan will be to add fat until an ideal contour is achieved and then we have to let it heal and see how much persists.  Because the amount of fat that survives is variable, some patients require a second and rarely even a third fat grafting procedure to reach the desired endpoint of improvement.  As fat grafting can be performed as an office procedure under mild oral sedation, and fat grafting recoveries are brief compared to traditional lower blepharoplasty surgery, supplemental fat grafting procedures are easily accomplished.

Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 48 reviews

We avoid fat injections to the under eye areas

The lower eyelid skin is very delicate. It is also very thin. Any irregularity shows through. One of our most common reason for performing revision lower eyelid surgery is palpable and visible lumpiness from prior fat injections. Many of the revisions are minor. Often, however, there are uncorrectable problems from gristly fat located in many planes of tissue.

The reason for this is in the biology. Fat injections cells are harvested by liposuction. the fat cells are then usually spun in a centrifuge and then injected back in. During this process, most cells die. The number is debatable, depending on whether the viability is judged by microscopic examination of the cells (ie trypan blue exclusion method), or by metabolic methods, measuring the cellular machinery.

However, the number of live cells is in my opinion between 3% and 25%. The rest are dead. As the dead cells are eaten away, an inflammatory reaction develops characterized by macrophages (large white blood cells), chronic inflammation and coalescence of fatty cysts, or dead liquid fat. We have presented and published our results on the histology of fat injection specimens.

We have found the belief that volume existing at 6 months after fat injection technique consists of live cells to be false. Rather, the bulk that remains consists of all the cellular elements above, still very actively eating away and walling off the dead cells and fatty cysts. The bottom line is that intense cellular changes continue to occur with fat injection, usually characterized by further loss of fullness, even at 1 1/2 years after injection.

This does not mean that there are not many happy patients out there with fat injections to the lower eyelids. There are especially when the technique is conservatievly performed in highly skilled hands. Just be cautious before injecting fat into the lower eyelids.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 103 reviews

Open Structural fat grafting is most effective and safest treatment

I have had great luck with open surgical fat grafting to correct dark circles under the eyes.

I avoid filler and fat injections. injecting around the eye is dangerous, in my opinion. There has been a reported case of blindness following filler injection around the eyes in England and the companies that sell fillers do not recommend that fillers be injected around the eyes.

FAt Injection to lower eyelid must be performed delicately

Fat grafting is great tool to improve lower eyelid condition. Micro grafts of patients' own fat can be safely placed in the hollowed area below the eye and nearby structures. This injection will fill the hollowed areas and improves the skin condition. There is early evidence that mesenchymal stem cells naturally contained in the fat grafts stimulates regenerative properties of the skin. Caution must be used to place only small amounts of fat. Over-injection and misplaced fat will be hard to correct. Best wishes, Reza Nabavian M.D. Clinical Assistant Professor of Plastic Surgery Keck-USC School of Medicine

Reza Nabavian, MD
Santa Monica Plastic Surgeon

Better for hollowness

Fat injections around the eyes have to be done very carefully. There have been reports of emboli causing blindness.  FUrthermore, the fat injection will probably not improve the dark circles if it is due to pigment changes.  It can help depressions but can also result in lumpiness.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Fat for lower lids

I stopped doing it in my practice because restylane was so darn effective, safe, easy , and removeable if needed. I don't waste my time with fat in the lower lids and don't recommend it to my pateints. also restylane in the lower lids lasts a long time (up tp 2 years). good luck

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

Fat Transfer for Lower Eyelid Hollows & Dark Circles

There is no known predictable procedure that will remove dark circles and/or hollowness. However, if fat is done in micro fat transfers there has been some early data to show that it may improve, but one must be very careful not to have irregularities and a potentially unsightly appearance after having this transfer done. I would wait for further studies before proceeding with any such procedure.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

Fat transfer under the eyes

Fat transfer can give an excellent result. However, it must be done very carefully as excess fat grafts in that area can leave lumps that are very difficult to correct. Seek someone very experienced for this surgery. Also fat grafts can be unpredictable. Still, if properly done by someone skilled, it is an excellent technique, and it will reduce the shadow under the lower eyelid as will other fillers.

Fat grafts should always be injected with micro cannulas and not needles, especially around the eyes, and the injections must in the smallest increments. Also one must be conservative even though it means you may need to return at a later date for a touch-up under local anesthesia

It is safe... may be permanent... but can have complications

Fat transfer is a very common procedure and done frequently for the face. If the fat is of good quality and concentration, and if it is skillfully injected, then a large portion of the fat will survive the transfer. That result can be relatively permanent. There are other non-permanent products, like Juvederm and Restylane, that can be used for the same indication. The difference is that swelling and redness is significantly decreased with Juvederm and Restylane. Fat transfer to the hollows under the eye can have a much longer period of swelling and redness. Also, some patients have lumps that can be seen or felt if the fat is injected too superficially. Those are the pros and cons... the decision of which filler to us is ALWAYS ultimately up to the patient. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon

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.