Sunken and Crepiness Under Eyes - Houston, TX

Initially I saw a dermatologist and requested...

Initially I saw a dermatologist and requested laser treatments for under-eye hollowing and crepiness. She informed me lasers would not give me the desired results I was looking for and recommended lower eyelid surgery. I saw Dr. Basu who didn't think I was ready for a full eye bleph and recommended a fat transfer from my stomach to under my eyes. The total recovery time was a full two weeks before all swelling and bruising completely disappeared and I was really freaked out my eyes would stay that way for the first week. Fortunately my recheck was on day 10 and I woke up looking less swollen and bruised and could tell I was going to love the results. I'm completely happy to date, but waiting for the three month mark. Dr. Basu assured me that would be the completely healed point and we will be able to see what "stuck" and if there is any loss of the grafts. I hadn't worn contacts in years because I felt my glasses covered the "aging" part of my face (under eyes). Two weeks ago, I went to see my eye doctor to get back into contacts. She said: Oh my gosh, I love your new hair color! It makes you look 10 years younger! Here's the thing, I have the same hair color as I did the last time she saw me. I wasn't trying to take 10 years off, I was just trying to look "fresher" but judging by the comments and reaction from people who haven't seen me in a while, I'd say it was a success. Will add another photo at the three month mark.

?The pain was easily controlled with...

The pain was easily controlled with two extra strength ibuprofen and I never used any other pain medication. In all honesty though, I rarely if ever take pain meds as they make me sick to my stomach. The doctor was worried that I maybe uncomfortable the first day or so and prescribed three Valium. I took one the first night after the procedure before bed along with two ibuprofen and never needed another.

Houston Plastic Surgeon

Dr. Basu listened to my concerns and I really appreciate the fact that he chose a more conservative route before jumping in with a major surgery. He answered my questions realistically and I didn't feel like he was pushing me to make any decisions I wasn't comfortable with. His staff was friendly and Shannon, the nurse who attended me during the procedure, was the same one to follow up with me during the aftercare visits and was really helpful in answering all my questions and concerns.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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Can't wait to see your 3 month photi
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Sorry for the novel by the way. I just wanted to say that the reason I posted the doctors comment for you was just for your reference in case you were aware about this or not. :)
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Thanks for the info, Simk420. Yes, I had read up on the procedure and made sure that my doctor was using the latest technology. I know since your first procedure (10 years ago) things have changed considerably and as long as you use a doctor with a proven track record and you can actually see photos of under eye fat graphs the doctor has performed and you meet and have a good rapport with one another, that's the best you can hope for. Good luck and please keep us posted if you decide to go forward with the procedure. Thanks again for your considerate email :)
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No problem. Thanks for the feedback. At the moment I am doing a couple consults to find the best plastic surgeon for me, that has the experience and knowledge of fat grafting. Thus far I have narrowed it down to 2; one of them is from Toronto, Canada where I reside and the other is in New York (the same doctor I forwarded you the post in my initial comment). I will have a decision by mid July. I definitely want to go through with it, but currently I have almost 2 syringes of Restalyne in my tear troughs so I'm also going to wait until they are depleted. Since it's almost been a month how are your under eyes now? Do you notice a difference and about how much % of the fat do you think survived? Also, do u notice any lumps? Best Wishes.
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I will post photos soon. I would say 80% stayed, which is what he told me to expect. I don't Hi again! Nope, I don't have any lumps, but he was very specific about gently massaging and hardening spots in round circles if and when I felt any. On about day three, I would notice a spot here or there and rub it out in circular motions a couple times a day. In about 2 weeks I'll be at my 3 month mark and according to the doctor I shouldn't lose anymore after that point. I'm hoping I can get some of the before and after pics from him when I go for my final check up. I don't feel like my photos really do it justice. Hope your procedure goes as well as this and you're as happy with your results as I am with mine.
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That's so good to hear that you're satisfied with the results. I'm glad they were what you wanted. I will update you as soon as I get the ball rolling through my end. Do you know anything about fat graft? (its basically fat that is removed from the body part that still has a blood supply as opposed to a fat transfer which is injected). A doctor in Boston by the name of Brooke R. Seckel, MD, FACS specializes in that. He has some comments on this website which i found interesting. His views on fat grafting vs fat transfer is quite compelling. I'll add his comment and link below: "Injection techniques around the eyes are "blind procedures" and accuracy is difficult to achieve. Injections around the eyes are traumatic and often leave visible lumps and discoloration of the eyelid skin. Blindness has been reported following filler injections around the eyes-the filler material enters a blood vessel and disrupts blood supply to the retina. Fat injection techniques kill a great many of the injected fat cells so that survival of the fat is very difficult to predict. In addition lumps and irregularities are common following fat injections in the eyelid area-the eyelid skin is so thin that any irregularity beneath the skin is very visible. For these reasons and to achieve the best result when treating hollow eyes after blepharoplasty or treating dark circles under the eyes, I use a fat transplantation technique in which a whole piece of fat of proper size to achieve restoration of volume is surgically transplanted under direct vision into the appropriate position, through a small laser incision on the inside of the eyelid. Placing the incision here avoids disrupting the lower eyelid support by making an external incision and cutting through the muscle. The later technique causes the sad eyed look or ectropion." Brooke R. Seckel, MD, FACS http://www.realself.com/question/What-is-transconjunctival-open-composite-fat-grafting Also two other links from Dr. Seckel in which he further explains those procedures. Feel free to take a look at your convenience. Link 2 Dr.Seckel's blog on "Removal of Dark Circles under the Eyes": http://drseckel.com/surgical-procedures/result-oriented-removal-of-dark-circles-under-the-eyes/ Link 3, Dr. Seckel's article on "Open Fat Grafting For Correction of Hollow Eyes and Dark Circles" : http://ezinearticles.com/?Open-Fat-Grafting-For-Correction-of-Hollow-Eyes-and-Dark-Circles&id=1778109 I should also point out that the majority of plastic surgeons no longer use fat graft as it is an older technique and now most surgeons use the new technique of fat transfer. I'm just trying to find out as to why did they abandoned this method because from reading the information about fat grafting, it seems to me like a better method since survival rate of the fat is much higher as it already has a blood supply. I don't know I'm just thinking out loud. Just wondering if you have any thoughts.
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Thanks so much for your post. I’ve had mine done approximately 10 years ago. But, my results were not great as the fat did not stay, and I felt like the fat had moved towards my cheeks making me look like I had cheek bones, (which really bothered me because as a guy I don’t need bigger cheeks). So, safe to say that I felt like the fat transfer for me was a bit of a fail. I just read from a doctors post responding to a question regarding fat transfer which I found quite interesting. I will attach the link and his response below. I was wondering from the time you had your procedure to today, how much of the fat survived in the under-eye hollow region, and if any of it moved south towards your cheeks? The reason I ask is because I am thinking about doing the fat transfer again for the under eye hollow region. This time with hopes that the fat will survive in the under eye-hollow’s and that the fat will not move south towards my cheeks again. Also, here’s a quote from the doctor I was referring to. And thanks again: http://www.realself.com/question/for-fat-grafting-specialist-guarantee-there-complications#1352508 “There are many factors to consider when approaching Fat grafting AKA Fat transfer. I will try to explain these factors which the plastic surgeons are taking into consideration when performing this procedure and why asking for a guarantee may be too much to ask for. Perhaps avoiding complications is possible, if very little fat is grafted, the smaller volume of fat transferred should reduce the risks that you are worried about, but then the results may be too subtle to be noticeable, which then begs the question why go through it at all. I think using fat has the potential to be great, since is it your own tissue and the transfer of fat cells are permanent once it gains a blood supply. Since it is alive and has a blood supply, if there is any infection is can be treated with antibiotics and it can clear infections as it does with normal tissue. It can't be rejected with an immune reaction called a foreign body granuloma or form a biofilm which is an infection on the surface of an foreign implant (pacemaker, breast implants, facial implants, joint replacements, etc). Having pointed out the Pro's, I am careful not to represent Fat Transfer as a Panacea or "cure all" solution. It is known that Fat survival after fat transfer is unpredictable. Surgeons know that fat survival can range from 50% depending on some strategies or techniques. They have tried different methods to increase fat survival percentages, by adding PRP (platelet enriched plasma), enrich stems cells and add it to the fat, wash the fat, spin the fat, only take the bottom 50% of centrifuged fat (stromal fraction) which has a higher fat surival percentage than the top 50%. The top fat transfer experts who harvest plenty of fat may even discard all of the top 50% of centrifuges fat and only use the better stromal fraction fat for injection to get a higher fat survival rate closer to 70-80%. Some surgeons may not be aware of this and may load the syringes and have stromal fraction (better fat) injected on one side and the worse fat on the other side and the fat survival between the two side may look quite different. A special centrifuge invented by a Korean plastic surgeon called Adivive uses a weighted mesh filter and higher centrifuge speeds to squeeze the fat harder and pop any "older fat cells" which cannot withstand the higher G forces. The reported fat survival rate using Adivive is closer to the 70-80% which is more like having all of the fat centrifuged closer to the stroma fraction type of fat. The Adivive users are cautioned not to inject this fat not the same way as regular fat transfer, otherwise the patient may get a big surprise of being overfilled, because the fat doesn't shrink down 50-70% after the first 6-9 months. There are two strategies for Fat Transfer performed by experienced surgeons who regularly perform fat transfer. The surgeons who do not want to perform as many touch up sessions and have the patient go through multiple recoveries may inject double or triple the amount of actual fat that they want to survive. These patients can look very bad, even "monstrous" according to some surgeons, initially after the procedure. As the swelling comes down and the fat that will not survive begins to get absorbed, it begins to look more and more normal. If they are going for this strategy of "One and Done" then the patient will look distorted initially and "overfilled" only to realize the real result later. If the surgeon is going for a single session of fat transfer and is not planning to do any touch up sessions, if the patient looks good immediately after the procedure, then too little fat was injected, since only a third of the fat may survive, assuming the surgeon at least purified the fat through centrifugation or a closed wash system like Puregraft by Cytori. If they did not bother to purify the fat at all and simply reinject the fat, the survival rate may be as low as 5-10% since the impurities of oils from damaged fat cells and blood in the fat causes inflammation which reduces the fat survival percentage. Most doctors who do believe in Fat Transfer already know this and will purify the fat. Other surgeons who regularly perform fat transfer may inject only the amount that looks good as during the initial injection, knowing it will not be enough, but then repeat the same fat grafting one or two more times. Patients are told that they may need a second or third session, typically at a discounted rate from the initial session. The same liposuctioning harvest would need to be repeated again and the purification of the fat would need to be repeated prior to injection. Since the goal is to be conservative, then it may be okay to look normal but fuller immediately after the procedure, but much of this initial fullness will go down by 2/3rd's because that is the typical percentage of fat survival. Since less fat is injected, the chance for lumps should be low. This strategy will likely require at least one additional fat transfer session to get the aesthetic result that the patient desires, if not 3 sessions total. If the fat survival in the first session was surprisingly high at 50%, then two sessions may be enough, but if it was average at 30% then three may be the number. By understanding the fat survival percentage, this makes more sense of the Surgeon's strategy for Fat Transfer. Aggressive surgeons will likely aim for a Single session, and conservative surgeons will inform the patient of multiple sessions to prevent overfilling with fat. If the surgeon wants 10 cc's of fat to survive, and doesn't know if the 3 or 5 cc's will survive, then they can wait for the fat to settle and repeat. If both sessions of injecting 10 cc's of fat had about 5 cc's survive then it is two sessions. If only 3 cc's survive each session then it would be 3 sessions. It is also possible that one session may be 3, or 4 or 5. It is unpredictable and that is the least of the issues. Let's say 10 cc's looks good and 11-12 looks a bit puffy and 13-14 cc's looks weird. If the surgeon predicts 30% survival and injects 30 cc's to get 10 cc's to survive, but the patients fat is great quality and has 50% survive, then that would mean 50% of 30 cc's survives or 15 cc's.” George Yang, MD New York Facial Plastic Surgeon.
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The third picture looks promising! How are you?
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Hi Leontine, I'm doing great. I hope to get some more recent photos up soon. Thanks for asking!
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Welcome and thanks for sharing your experience with us!

I'm so glad you're happy with your results so far. How was your recovery period? Is there much pain after this procedure?
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Thanks for the welcome, Kristy. The pain was easily controlled with two extra strength ibuprofen and I never used any other pain medication. In all honesty though, I rarely if ever take pain meds as they make me sick to my stomach. The doctor was worried that I maybe uncomfortable the first day or so and prescribed three Valium. I took one the first night after the procedure before bed along with two ibuprofen and never needed another.
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