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Restylane Vs. Fat Grafting for Under Eye Hollows?

I'm of East Indian origin and I have hereditary dark under eye circles. I have very thin skin under my eyes and a deep depressions in the inner cornes of my eyes and wrinkles. I'm trying to decide between getting Restylane injections to correct the hollowness or get Fat Grafting. I've read some pretty scary stories about both procedures and I'm not sure which is safer. Thank you

Doctor Answers (8)

Far Grafting for under eye hollows - See Photos for evidence

+5
Look at the experience and photos from a plastic surgeon before deciding. Please see the link below with many before and afters of fat grafting I have performed.
A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume, are naturally thin or hollow, or have developed noticeable and bothersome lines and creases. The most popular fillers currently are hyaluronic acid products like Juvederm® and Restylane® which can be used to, among other things, plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). In this practice we have performed thousands of injections with these safe and reliable hyaluronic acid fillers. They are well-tolerated by almost all patients and they produce very few post-injection problems. The improvement generally lasts from four to eight months, the average being about five to six months. Of the available hyaluronic acid soft tissue fillers, I have been most pleased with the performance of Juvederm®.
Other injectable fillers are currently available which attempt to produce a longer-lasting soft tissue augmentation by incorporating substances that are more slowly metabolized or that cannot be metabolized by the body. These are sometimes referred to as 'semi-permanent' fillers. Some incorporate non-degradable biologic materials (e.g. Radiesse®, which contains calcium hydroxyapatite, the mineral component of bone) or non-biologic (synthetic) materials (e.g. ArteFill®, which contains polymethyl methacrylate, also known as Lucite) that are designed to persist in the body permanently. Another is Sculptra®, which consists of a synthetic polymer called poly-L-lactic acid, which is also used as an absorbable suture material.
Unfortunately, the body treats these materials as foreign objects, and as a result the placement of non-degradable and synthetic materials may lead to inflammation, infection, migration and granuloma (an inflammatory cyst) formation - none of which are problems that you want to experience near the skin surface in your face. In general, the 'semi-permanent' injectables containing these materials are less likely to produce a result that looks and feels natural, and because of the potential complications I feel that they should never ever be injected anywhere close to the skin surface. We do not use any of these injectables in my practice.
If you are looking for a longer-lasting result than you are getting with Juvederm® or Restylane®, we have a much better solution for you: you own fat, currently residing somewhere that you don't need it. The improvement is designed to be permanent, and your body will not treat it as a foreign object. Your immune system won't attack it. The cost is about the same as several syringes of a 'semi-permanent' filler. And the quality of your facial skin may, in fact, actually improve in the areas where fat is grafted.


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 41 reviews

Restylane is temporary and fat injections can last years

+5

Restylane will last about 6-9 months but can improve this area. Fat injections can last 8-10 or more years. You are one the right track though. You need volume in this area and that's the best way to improve this area. One thing to realize is that restylane will go away and can also be taken out earlier if you wish through enzyme injections. This can be reassuring.

Fat injections are more permanent and is a little harder to get rid of if you don't like the volume but can be done through different special procedures. In my opinion, fat injections / transfer leads to the most natural results.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 37 reviews

Fat injection vs Restylane

+3

Fat injection, even in the best of hands, has the chance for lumpiness. This lumpiness can be difficult to correct. Especially in young patients we prefer Prevelle or Restylane.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews

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Filler vs. Fat injections

+2

Restylane or Juvederm, both hyaluronic acids, are commonly used, off-label (not FDA approved for this use, but doctors may legally perform the procedure) for this purpose.

Fat injections may give you a good result but, there are different ways that both of these fillers are done by different doctors. Some inject over the muscle, and there may be larger chance of visible bumps.

The nice thing about Restylane or Juvederm is that if there is too much filler injected, it can be dissolved by injecting hyaluronidase. This also can be used in case of serious complications, such as a plugged blood vessel, whereas there is no equivalent of hyaluronidase for fat injections.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Restylane Vs. Fat Grafting for Under Eye Hollows

+1

Both procedures are safe if done by a provider with experience in tear trough fillers. Fat is a more permanent option, as Restylane only lasts about 6-12 months under the eyes. I recommend doing non-permanent fillers first to see if it meets your expectations. Then if you are satisfied with the results, you can opt for a more permanent filler, such as fat grafting.

Tim A. Sayed, MD, FACS
Palm Beach Plastic Surgeon
5.0 out of 5 stars 14 reviews

Options for lower eyelid treatment

+1

Fat grafting involves taking live fat cells, protecting and processing them, and re-injecting or placing them in an area where more fat or bulk is needed.  In regards to safety for under eye correction, there is a greater possibility of irregularity of result with fat transfer than with fillers such as Restylane.  That is because it is difficult to place very tiny strands of fat under the very thin skin in the tear trough area, and therefore slight lumpiness is sometimes seen and is not desirable.  However, there is a way to combine fat grafting with lower lid blepharoplasty where the fat is injected underneath the skin into the bulk of the orbicularis muscle.  The procedures are safe under the hands of a a board-certified plastic surgeon with experience in these types of procedures, who is conservative in his approach.  It is important to discuss the various options available to you with your surgeon of choice.

James Carraway, MD
Virginia Beach Plastic Surgeon
4.0 out of 5 stars 4 reviews

Restylane vs fat for under the eyes

+1

Restylane is temporary but is more forgiving in that it can be molded.  Fat is permanent but may cause more lumps that are more difficult to deal with thatn restylane.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Restylane

+1
Although you may have heard scary things about both procedures the incidence of them happening is quite low. That being said the potential bad things that can happen from fillers are generally less severe and usually reversible when compared to fat transfer.
You are young and your lower lid contour is relatively good. I would recommend beginning with filler. You don't burn any bridges and I beleive you will be pleased with your result.

Robert W. Kessler, MD, FACS
Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 89 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.