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Upper Eye Hollows - Pearl Fat Grafting - London, GB

I had a CO2 laser treatment in August 2007 around...

I had a CO2 laser treatment in August 2007 around the eye area. After about 3 months of having this treatment I was left with horribly hollow ugly eyes. At first I did not understand what had changed about my face.
In 2010, I was on this site (realself) and I suddenly recognised that the condition I had, had a name, "upper hollowness of the eye". I also discovered that this there were possible treatment optons, fillers, fat injections or pearl fat grafting (from Dr Meronk's excellent website).
I did not want to go down the temporary filler route so chose fat grafting.

In June 2011 I contacted Dr Sorensen (in London) and had my consultation. I didn't want scarring so we decided that we would go down the fat injection route.

Unfortunately the improvement was minimal. The hollowness was due to lack of fat in the actual socket so I didn't get the result I wanted. The brow was fuller put the hollowness was still there.

I returned to Dr Sorensen for actual pearl fat grafting in 05 Dec 2011. The discomfort was minimal post procedure. I made sure I slept in a sitting up position for 2 weeks to keep the swelling down. There wasn't significant swelling.The immediate result was quite lumpy especially when I looked down or closed my eyes. I had a bit of a panic attack because I was afraid that the lumpiness would stay. I visited Dr Sorenson a week after the procedure to have the stitches taken out. I used this opportunity to tell him of my concerns regarding the lumpiness. He said that we should give it a little while and that if it didn't resolve he would remove the lumpiness without any cost to me. So, I had the procedure on 5 December and on New Year's Eve I went out to celebrate the new year. The recovery period was very fast.
The lumpiness began slowly resolving itself and after about 3 months I would say that it probably had gone more or less completely. Some days the hollowness looked like it had returned but I think it was dependant on my hydration levels.
So now I am 2 years post op, I wouldn't say the result is not perfect but I would say that I am very very happy with the result. The pearl fat grafting has improved the look of my eyes by about 250%.
Dr Sorensen is very conservative in his procedures but I do wish that he had put a little bit more fat in than he did. I am considering going back to him and asking him to put a little bit more in.

I hope this information helps others who are facing a similar problem.

no scarring from liposuction

Dr Sorensen performed liposuction around my abdomen and back at the waistline when he was harvesting fat for injection. Later he told me that he had gotten the very very good quality fat that lies at the deeper levels. He said that this also means that you don't get any bumpiness or irregularities showing up on the skin that tends to happen with liposuction procedures. I have just been looking at bad results for liposuction and seen scarring and irregularities. This makes me very grateful that I chose Dr Sorenson. I cannot see any liposuction scars on myself a all where the lipo "nozzle" thing was inserted into my skin. Thank you Dr Sorenson. :)

oops typo

Typo:
meant to say:
I cannot see any liposuction scars on myself AT all where the lipo "nozzle" thing was inserted into my skin. Thank you Dr Sorenson. :)
Dr Sorensen

During the consultation Dr Sorensen listened intently to my concerns. After the procedure he gave me his personal phone number in case I had any problems. When I returned to have the stitches taken out he seemed a bit rushed and he had a few people waiting in the waiting area. Overall though, the important thing is that he did a good job, so I am happy.

5 out of 5 stars Overall rating
3 out of 5 stars Doctor's bedside manner
4 out of 5 stars Answered my questions
3 out of 5 stars After care follow-up
3 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
4 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
4 out of 5 stars Wait tmes
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Your results look good, but how come he scored 3 for bedside manner and aftercare?
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In terms of aftercare, when I went to see Dr S post procedure (to have stitches taken out) I felt I was rushed in and out. I wanted to talk through my concerns regarding lumpiness of the fat. Dr S did have some people in his waiting room and maybe he was running late but I just needed some reassurance. He did say that if the lumpiness didn't resolve then he would correct at no cost to me. Luckily the lumpiness did resolve itself, it took about 3 months. Maybe if I had needed this extra sugery then he would have scored higher in terms of after care. The after care score was based on the fact that I felt rushed. In terms of bedside manner, Dr S is very matter of fact. He gives you the facts and there's no "hand holding" or anything. But I've read on this website, that some doctors appear very caring, showing lots of empathy, etc and have a great bedside manner and then they do a rubbish job which requires subsequent revision. Personally I would prefer someone who is very matter of fact and does a good job. Dr S did an exceptionally good job on my eyes. When I find the time I plan on a follow up consultation with him with a view to add more fat (via fat injection) and maybe even get an abdominal muscle repair (due to pregnancy). The incision he made to remove the fat pearls was sewn up extremely neatly. I was very impressed.
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If you have more fat placed you would do so by fat injection and not another pearl fat graft? The reason I ask is because one of my fears of the surgery is not having enough fat or having the graft fail and having to have more fat placed. Some surgeons do not like placing second pearl grafts. My eyes have already had surgery with the original bleph so I fear that my graft would not take as well as someone with "virgin" eyes (no prior surgery). I have also read that fat injections do not tend to take as well. What are your thoughts on the matter? Thank you so much for the info you've been giving; it is really generous. It's so hard to get any info on pearl grafting.
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I would choose to have fat injections not pearl fat if I had 3rd fat grafting procedure. The reason is because I feel the orbit now has sufficient fat and I would prefer not to have my eyelids cut open again. I feel the area under my eyebrow would benefit from more fat, I quite like the look of slightly hooded eyes. I also would like some fat in the under eye area (tear troughs). The fat that was injected in around the brow area survived really well. I feel about 60% survived in the first round of fat injections. And I feel about 90% of it survived during the second round of fat injections. I think that for the second round of fat injections there was already a good supply in place (due to the first round) and it was like my body now knew what had to be done. Dr S is conservative in his approach as he feels it's better and easier to add more fat than to have to remove it. I totally agree with him. The overly aggressive approach some doctors take can be devastating. I have read on the internet that secondary and sometimes tertiary fat pearl grafts are required. Smokers tend to have poorer results. With the pearl fat grafting, I feel that all the fat survived except the lumpy bits. Perhaps the action of opening and closing the eyelid caused some sort of frictional action that killed off the fat cells that were sticking out too far and causing the lumps. Note that during the first year after surgery sometimes my eyes would look slightly hollowed again. I would feel devastated that the graft didn't take and then the next day, my eyes would look fine. The pearl grafts took a little time to settle in and when I was dehydrated or tired my eyes would look more hollow. But they never looked as hollow as they did before the surgery. Fat injections are done in the brow area, just underneath the eyebrow. They do not address the issue of the empty orbit. With me, when my orbit was empty, my eyes would get really tired and ache after just an hour or so after waking. They would also become bloodshot. After I got the pearl fat grafting and the fat settled in, I no longer suffered from this issue. My eyeballs needed some sort of cushioning and the pearl fat provided that. If you suffer from tired eyes due to lack of fat in the orbit then fat injections will not relieve this condition and you definitely need the pearl fat. The fat injections can only try to disguise the empty orbit. The pictures on Dr Meronk's website show patients who had previous blephs and their pearl fat take was good. He even has pictures of people who look very elderly. If their pearl fat grafts can take, then I feel sure yours will too. I hope the next thing I am going to say will help you, I was concerned just like you, will the fat take? how badly will I be scarred? how do I know how good the doctor is? etc, etc. In the end, I just bit the bullet. I did all I could to try to make sure I chose the best surgeon I could. After that I was in his hands. I wish that I had found Dr S earlier and not suffered with hollow eyes for so long (2007 to 2011).
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Thanks sunshyme for clarifying. Bedside manner is a funny one. I've had bad results from 2 - one had a good and one had a bad bedside manner! LOL. I think that's interesting Dr Sorensen said he would correct any lumps should they occur. The upper eyelid I hear is VERY tricky although I haven't had a fat graft there myself. I am wanting to correct a bad FT and didn't know whether to see Dr S or not. I may call his office, but not sure whether he'd be willing to correct what I have. Anyway, I would say that you should reconsider having another fat graft as your eyes look good as they are.
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Hi Unoq. Sorry to hear you need FT correcting. The lumpy fat that Dr Sorensen offered to correct (if necessary) was the pearl fat. This fat is contained in one area, behind the orbital septum so I think in the right hands it is fairly easy to remove or add to. It is not distributed through the various tissue planes of the face as is the case with fat injections. I hope you are able to find a solution. Goodness me, there's far too many doctors botching peoples' faces. And there's far too many of us spending years trying to find ways of correcting our botched faces.
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Your eyes look great - what a wonderful doctor you have!
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Sunshyme, many thanks for this, very helpful. I am trying to understand how the eye fat grafting is combined with the liposuction. Were they performed by the same doctor in your case. Was it a proper liposuction or just for the purpose of fat harvesting. And also, the amount you quote - 5000 $ - is that for the combine procedures? I am in the mist of finding the right surgeon and the differences in price quotes are very confusing.. Many thanks
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Anais777, sorry, realself didn't send me an email alert telling me that you had left a comment. The first surgery cost £3000 (pounds sterling) and involved fat injection around the eye to disguise the hollowness. I made the choice that I wanted fat injecting because I did not want scars. The injected fat came from liposuction. The liposuction was ONLY for the purpose of fat harvesting. I went back to Dr Sorenson because the hollowness was due to an "empty" orbit and I decided that I would risk eyelid scars. The 2nd surgery was a reduced price of £2000 because it was a repeat surgery. During the second surgery Dr Sorenson said he would inject some more fat around the eye as well. So he basically used fat pearls AND fat injections during the 2nd surgery. I wish I had gone down the pearl fat grafting route during the first surgery then I wouldn't have had to have the second one and the cost would have been £3000 in total (about $5000). It was my choice and Dr Sorenson let me make my own decision. He did not encourage or push me into a decision that I might end up regretting. Finding the right surgeon is a horribly difficult task. Luckily this website, realself helps us so that we are more informed and know which questions to ask during our search. I wish you well. PS make sure you have a look at what a surgeon's previous patient's scars look like. Some surgeons don't care how they sew you up and you are left with big ugly scars. Other surgeons are careful and meticulous and leave you with a scar that is barely visible.
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Sunshyme, I am very grateful that you took the time to answer, this is MASSIVELY helpful! None of the two surgeons I've seen showed me pictures of their previous work. Although they both have a good reputation, none of them is a specialist in oculoplasty and assured me that this is not necessary to perform the fat transfer. At this point I might consider travelling to London to see Dr Sorenson following your glowing review. Will keep you posted. Many thanks once again
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I am thinking about doing the same thing. Since Dr. Meronk retired, I really don't think there is anyone who does this a lot. I am thinking of getting an in person consultation with Dr. Shorr, but he has mixed reviews and is very expensive. Anais777, is the hollowing you have caused by upper bleph? Have you tried fillers?
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No, not bleph. Actually in my case I have a congenital problem, I have hollowing of one eye only - it goes with half the face lacking fat but this is not too noticeable - and the difference between the two eyes is very noticeable and very annoying. It gets worse with age and when I'm tired - the hollow eye gets red too. My eye doctor recommended the plastic surgeon but the more I read about it the more concerned I am about having this done by a general plastic surgeon and not one specialised in oculoplasty. I'd prefer fat transfer because of the possibile infections with fillers - biofilm - and because I tried fillers before and they take forever to dissapear in my case. So i the result is terrible with fillers I'll be stuck with it for at least 5 years. If anyone has a similar problem and any advice, I'd appreciate it.
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Hi Anais777, please understand that the result is NOT perfect. You have to have realistic expectations. These surgeons are human not God. With me, the result after surgery is significantly better than what it was before surgery but it is not perfect. Recently, I found out that Dr Sorenson is not BAAPS registered. I was stunned by this. I didn't think to check before I had this surgery. Would I have gone through with the surgery if I had known at the time? I really don't know. These decisions are really tough. I really don't think you should go to anyone who can't show you previous befores and afters. Basically, what I have realised is this, sometimes surgeons want and need to practice a new technique on someone. Unfortunately for us, the people they practice on is US!! This means that we are paying them thousands of pounds when they are not proficient in a technique. The end result is that we might end up disfigured. When we complain, the surgeon's response will be "it looks okay to me, I have your money, now run along and don't bother me again". Basically, what I am saying is, see the before and afters, look at the scars and also ask the surgeon to describe the procedure in detail with regards to what he is going to do. You should also do your homework and find out what the procedure involves so that you can make an educated decision with regards to which surgeon you choose. Also, I would suggest that you email the surgeons in the first instance with pictures (which is what I did) and ask them if they can help you, what they suggest, and how many of these procedures they have done in the past. The ones that provide responses you like, you can choose to schedule consults with, the rest you can discard. I really wish you the best.
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When you say the result is not perfect what don't you like about it? I know nothing is ever perfect though. You're eyes look very good to me. I've heard that the fat is firmer than the native fat in the eye. I've consulted someone here in the U.S. that told me I should go with fillers because the fat is different and is firmer and tends to fall forward over time and can lead to eyelid hooding. Have you noticed this?
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Amyz99, the result is not perfect because I would have liked more fat to have been added. Also the right eye at the outer corner seems to have not been filled properly. This is only obvious to me and not to other people. Also the presence of the scar means that I can feel a ridge in my upper eyelids whereas previously it was completely smooth. BUT the procedure was definitely WORTH IT. My eyes look much better than they did before. I no longer look, skeletal, ill, old. If I had to go through it again, I would. The most important thing is that there is a significant improvement. I am very grateful to Dr Sorenson for this. After the laser treatment I hated looking at my reflection because all I could see were these hollow elderly eyes looking back at me. Now, I look at my eyes and I admire their shape. I appreciate them more now than I did before. I am thinking of going back to Dr Sorenson for more fat to be added. With cosmetic surgery you have to know when to stop so that you don't ruin your face. Since my eyes have improved so much I wonder if maybe now is the time to stop. Basically I am going between feeling I need to go back, to feeling I need to stop. The fat doesn't feel firmer, although initially I was very conscious it was there because I could feel it when I blinked. It has been two years and cannot feel it anymore and I have had no problem with regards to eyelid hooding. To be honest, I like the look of a slightly hooded eyelid and wouldn't mind getting that result.
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Hi again Sunshyme, I heard that Mr Sorenson has the Danish equivalent of BAAPS. Following on from your point though, I have read of experiences of others on the UK forums that choosing a BAAPS surgeon may not protect you from a poor result. And some do practise/experiment. I found this out to my cost! They tend to stick together and won't particularly criticise another BAAPS surgeon's work if the result isn't good. The surgeon who did my upper lid Bleph was BAAPS and BAPS, but still ruined my eyes taking fat and tissue and not just the excess lid skin as requested and discussed. Mr S told me it was the old fashioned method (1970s - 80s era), and that I have mild A frame deformities and asymmetry as well as sunken eyes as a result. He thought he could correct this for me with what he called a volumising Bleph - not just fat grafts. Thank you again for your replies as they are so helpful. Likewise I will post the results I get from any corrective work.
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Spirenot, I also had fat and skin removed that was not requested. My doctor said he would be conservative and was anything but. He didn't take out all the tissue, as I've seen some other work that left patients with barely anything left at all. I do have the a frame deformity too and a sunken eye look. I think I'm going to have filler placed temporarily until I can save money to do the fat grafting. Thanks for posting any corrective work.
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Yeah, I think it's good to follow your gut. He did a very nice job on your eyes. They look very pretty. If you do get more fat placed, please update. Did he say he would put more in for you? I know there is a risk of scar tissue.
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Hi Spirenot, thank you for that tidbit of information regarding Dr Sorenson (and him being Danish BAAPS). I agree with you that just because a surgeon is registered with an organisation doesn't mean you will get a good result. When you go for a consult you have to try to gauge how meticulous the surgeon is. With Dr Sorenson, I am aware that he performs some sort of microsurgery involving nerves. So I figure that he is quite meticulous and shows an attention to detail plus like I said he had good before and after pictures. Spirenot I hope you will remember to post the results and I hope that everything goes well for you. Realself is truly invaluable especially when people include pictures and an honest account of their experiences.
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Welcome!
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Thanks for posting this! I have post bleph hollowing and I hate it and want to find a permanent solution to this.
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Amyz99, please have a look at Dr Meronk's website. Unfortunately he is retired now but his website is extremely informative. You have no idea how many times I visited his site to try to educate myself so that I might find the right surgeon for me. I would have been prepared to travel to America to have Dr Meronk carry out this procedure on me but he had already retired. Search for "hollow eyes Dr Meronk". I believe this is a permanent solution. Initially when I had the procedure my eyes would sometimes look lumpy and other times look slightly hollowed. So I went from having panic attacks thinking that they were going to be lumpy forever to having panic attacks that the hollowness had returned. The fat took a little bit of time to stabililise and 2 years on I am extremely happy. :) I sincerely hope you can find the right surgeon for you.
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Thanks. I looked at the website and have been looking for surgeons. I want to find a specialist and there aren't any specialists in the US who do the procedure. I will have to travel to the UK to have it done, but I would travel anywhere to have this done right. I would be heart broken to spend the money and travel to have it fail, so want to find the right one. So does the fat feel normal in your eyes now?
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Amyz99, I think there are more surgeons in the US that have experience in this field than there are in the UK. I don't believe you will have to travel to the UK for this procedure. I think you are feeling desperate (I know because I have been there) and you will go to the ends of the earth to try to fix your face. I contacted Dr Stanley Frileck in the US. He was involved in a study and has written a paper on fat grafting to the eye hollows. Although in the study he used a sausage shaped piece of intact fact. But he got good results and by that I mean the fat stayed permanently. I think he now uses little pearl fat grafts because they yield a better result. I also contacted a few other surgeons in the US. Dr Sam Lam might have been one of them. There is also Dr Shorr ( search for Shorr Face Institute on the internet). I think my first choice in the US would have been Dr Meronk but like I said, he has retired. My second choice in the US would have been Dr Frileck. Unfortunately I can no longer find the link to his paper on fat grafting to eye hollows otherwise I would have provided it. When I initially suffered the hollowing my eyes used to get tired very quickly and ache. Now that I have fat to cushion them my eyes to not experience the same tiredness or ache. The fat feels normal and I enjoy looking at my face and eyes again. There was a time when I was repulsed by my reflection and regretted bitterly ever having the laser treatment. My advice to anyone is DO NOT HAVE ANY FORM OF LASER/IPL/FRAXEL/TITAN/CO2/ETC TREATMENT EVER. The heat causes the fat under the skin to be destroyed. Initially the result might look good because the skin is slightly swollen and it looks as if the wrinkles have gone. After about 3 months when the swelling goes down you will be left with extremely sagging, wrinkled, shrivelled skin. It is absolutely NOT WORTH IT. Going back to the eye fat: It is important that you begin eating well, drinking lots of water and taking some vitamin supplements now before your surgery. What this does is it helps provide the body with the raw materials it needs to heal quickly after surgery. Do not smoke or drink or take recreational drugs as this will hinder your recovery. It takes 5 days for the body to supply the fat with a blood supply so you have to be gentle with the eye area after surgery. I did not touch it at all. I didn't even wash my face or screw up my eyes or anything for a week. I wish you well.
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PS Avoid fluoridated water and also avoid GM foods. I believe in America they are difficult to avoid as they are not labelled. But if you eat wholesome foods and take vitamin supplements your body will be more ready to heal and allow the new fat to be grafted with ease. And as far as I am concerned the fat in my eye hollows has become permanent.
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