Ask a doctor

Is It Possible to Put Back Fat After Lower Blepharoplasty?

If the doctor takes out too much fat during lower blepharoplasty, making the eyes hollow-looking, is it possible to put back fat in the area? If so, what are some options for getting this done?

Doctor Answers 14

Fat grafting to correct hollow eyes after surgery

Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
I often perform structural fat grafting on upper and lowere eyelids on patients who have had overly-aggressive surgery perfomed by another physician that has left them looking hollow.


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

Have a question? Ask a doctor

Fat grafting can be used to correct over-resection of orbital fat

By using fat grafting techniques fat can be gently removed from another part of your body (e.g. abdomen, thighs, hips) and then injected into the hollowed out area under your eyes. Fat grafting in this area is very technique-dependent so you will want to have it done by someone who has extensive experience with this.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Fat replacement is not common

Fat replacement is not a commonly performed procedure, if ever it is performed at all. Fillers may be placed under the eyes to help smooth the surfaces.

 

For more examples of Dermafillers injected to the eyes, Click on the link below.

David Mabrie, MD
Bay Area Facial Plastic Surgeon
4.5 out of 5 stars 62 reviews

Replacing fat after blepharoplasty

Yes it is possible to place fat back into the lower eyelids after blepharoplasty.  Sometimes the fat can be repositioned. Other times the fat can be harvested from another site. It really depends on what the problem is to find the best solution. 

Chris Thiagarajah, MD
Washington DC Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Excess fat removal after blepharoplasty can be corrected by fat grafting.

If too much fat has been removed after lower lid blepharoplasty, fat grafting can restore the volume.  In the past, aggressive removal of fat was considered proper technique.  As perspective was gained on results, the removal of fat has become much more conservative and, in some cases, unnecessary.  Occasionally, miscalculation can occur and the patient may end up with a "hollowed out" look.  Replenishing fat deep to the orbital septum can help.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 13 reviews

Yes, fat grafting is possible

Yes, there are fat grafting techniques that can be performed. The fat needs to be put back into the proper anatomical position and into the orbital septum and not into the subcutaneous skin. If it is placed in the subcutaneous area it will look like a glob of fat in the wrong location.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Frat Transfer After Blepharolplasty

Hi Babyjoe,

Yes it is possible to perform fat transfer to the lower eye lid area after a blepharoplasty if it is felt that there is too little volume left. One should wait a few months to allow swelling to resolve and all healing to take place. The procedure is done with fat transfer and micro-fat injections.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Fat Can Be Transferred to Lower Eyelids

If too much fat is removed during lower eyelid surgery (blepharoplasty) there are methods to refill this area. Skilled cosmetic surgeons can transfer fat removed from other places in the body to the lower eyelid area. Prior to under taking this or as an alternative, fillers like Restylane and Juvederm can be used to refill this delicate area. Fillers in this area can last as long as 18-24 months. Preventive measures are best. Choose a skilled Ocular Plastic or Cosmetic Surgeon to perfom this procedure. When I perform this procedure I am very conservative in the removal of fat. I actually sit my patients up during the surgery to judge the amount of fat removed!

Mark Berkowitz, MD
Sterling Heights Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

Micro fat transfer with injections can often significantly improve this problem.

Fat transfer of your own tissue which can be harvested from the hip, thigh, or abdomen can usually provide improvement to the overly "hollowed eye." This is done with a micro injection technique.

It is not possible to predict the amount of fat which will survive and it is sometimes necessary to inject more than once if there is significant absorption of the fat. In some cases it may be helpful to elevate the soft tissues of the midface as well to disguise the infraorbital(below the eye) grooving. The fat transfer is a simple procedure which often takes less than an hour and has a relatively quick recovery.

Stanley G. Poulos, MD
Greenbrae Plastic Surgeon
4.5 out of 5 stars 8 reviews

The remaining fat can be repositioned outward.

To babyjoe,

Hi! Unfortunately, the hollow look after lower blepharoplasty is not rare. Here are some options that can be used separately or together. I recommend revisions only if the problem is significant. For a minor problem, injection of a filler like Restylane can help.

1) Even when a lot of fat is taken out, there is almost always some left. This remaining fat can be redraped outward to create a fuller look.

2) Fat injections can create a smooth transition between the lower eyelid and the upper cheek. The fat has to be injected with a blunt needle from below (though a little stab wound inside the nostril).

3) Tightening the lower eyelid and the corner of the eye (canthopexy) will create a less hollow look.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 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.