After 15 Years Fat Injections to my Tear Troughs Are Still Lumpy and Look over Corrected. Do I Have Options for Removal?

After 15 Years Fat Injections to my Tear Troughs Are Still Lumpy and Look over Corrected. I Have Been Told by 4 Top NYC plastic surgeons they cannot remove it or minimize it...With new technology, I am not sure why it can't be reduced with laser or some kind of injection... At 55 finally I am losing more of my own fat around the injections sites and the lumps are becoming more prominent. Three years ago I had a surgeon inject filler around the lumps to try to even out the area with some success but now the filler is gone and the area looks worse...Help!

Doctor Answers 5

Tear trough fat injection revision

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This problem typically needs an open surgical approach to improve it.  Liposuction tends to be ineffective because of the surrounding scar tissue and injections such as with a steroid can be unpredictable or cause further contour problems.  I would agree with the other post - Sydney Coleman has done more fat injections than anyone, and is in New York.  Get his opinion.

Fat in tear troughs

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Thanks for your question -

Fat injection in the tear troughs can cause contour deformity - exactly what you're describing.  The issue with fat transfer here is that the skin in this area is very thin and the distance between the skin and the bone is relatively short.  This means that injection contour can sometimes be seen through the skin.

Sometimes this fat can be directly excised as part of a lower lid blepharoplasty or through micro liposuction to try to debulk the area.  Typically more injections don't make things better.

Find experts in the area.  Syd Coleman has a great deal of experience in facial fat grafting and would be a useful consultation.  Good luck!

Photos would be helpful

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The degree of lumpiness may also be a factor in deciding what to do. If it is a very small bump, then a steroid injection may be an option. If there is major contour issues, then direct excision and removal is more appropriate.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Fat injections in the tear trough are commonly lumpy!

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Fat injections in the tear trough are commonly lumpy! I have been doing fat injections for 35 years and I don't put fat in the tear trough unless it is part of a blepharoplasty. You have 2 options: 1. more filler as you did before with Juvederm in small amounts 2. Revision surgery to remove the scar and fat. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Tear trough lumpiness from fat

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The anatomy of the tear trough is a connection of the orbicularis muscle to the bone and needs to be released to be eliminated. Fat under the eyes must be deep and directly on the bone. If it not deeply on the bone it is visible , lumpy and unfixable with , steroids, 5fu, or surgery. .

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

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