Can I still be bruised/swollen from Lower eyelid/fat grafting surgery after 3.5 months (photos)

I had lower eyelid surgery and fat grafting a little almost 4 months ago. From the looks of my photos, can you tell me if I am still swollen\bruised a little especially on the left where he did more work? Is this normal in some patients to be still healing? I still see some puffiness and a dark semi circle spot still at the area I had the most bruising. I'm hoping I'm just a slow healer but would like some opinions.

Doctor Answers 6

It appears you had fat grafted into your lower eyelids, which takes a long time to heal, and is unpredictable with results

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Thank you for your question. It’s been 4 months since you had lower eyelid surgery and fat grafting, and you’d like to know if it’s normal to still have some bruising, swelling, and a feeling of tension, particularly on your left eye.

Just a bit about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I specialize in cosmetic and complex reconstructive eyelid surgery, so I have certainly dealt with many cases such as yours.

Let me, as best I can without the benefit of a proper examination, first assess what I think may have happened. I think you had lower eyelid surgery in an attempt to address puffy under eye bags, though it appears to me that you still have the eye bags. I think your doctor’s strategy was, instead of removing the eye bags, they tried to transition and augment the area between the bulge and the cheek junction with fat grafting.

Fat grafting has been around for quite a while, and before the introduction of hyaluronic acid fillers, there was always a challenge when it came to augmenting areas of the face with volume loss. Fat grafting was an appealing option because it comes from a natural source — the fat from your own body. It heals well and has long-term duration, however, there is also a question of predictability and variability of healing, and prolonged swelling. This is because the fat is not pure fat, and it sometimes does not consistently take in the area it’s placed in. I usually tell my patients that (1) there is a 30-70% absorption rate of fat, and that (2) they might need a second procedure. This, however, is based on my own experiences.

When I study your left eye, I can see that below the puffy bag, there’s a little lump, and my suspicion is that there is an area of fatty tissue. As I mentioned before, fat grafting is not pure fat — it is taken out with liposuction and is a mixture of fat cells, supportive tissue, and anaesthetic fluid, regardless of how it’s spun and prepared. In our practice, we mix the fat with platelet-rich plasma and extracellular matrix, in order to improve viability, and I personally like using fat for the hands and certain areas of the face as we get really great results. However, I discourage using it around the eye area.

What you are probably dealing with is just the natural healing process, and this process can take a long time. In fact, I have met patients who’ve dealt with chronic swelling from fat grafting for years.

In our practice, what I usually recommend for prominent puffy eye bags is a lower eyelid transconjunctival blepharoplasty. Basically, we approach the eye bags from the inside of the eyelid, reduce the fat pockets, then afterwards, we’ll use laser and PRP to improve skin quality. In some cases, we’ll also augment the cheeks to give the face nice volume and balance, and we do this via a method called the Y Lift™. Our patients are usually able to go back to work in about a week with virtually no bruising and minimal swelling.

I think at this point, it is important to maintain communication with your doctor; perhaps inquire about some possible anti-inflammatories that they may prescribe you to help with the swelling. I would still like to point out that there is some significant puffiness under your eyes, which may require some additional procedures. Again, it has been 4 months after surgery so there is still time to observe what’s going on.

I hope that was helpful and I wish you the best of luck!

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Can't see

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It's difficult to tell what your lower lids look like from the photos you have provided.  Could you please post better photos where we can see your eyes.


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Thank you for your questions and pictures. It is hard to determine if this is swelling without pre operative pictures and a better view of your post operative pictures. Sometimes swelling can occur for up to 6 months post surgery. Best of luck.

Swelling post bleph

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It is hard to tell from your photos but they look okand yes you could still be swollen especially if you had fat injections.

Fat transfer to lower lids

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You are still pretty puffy but it doesn't look very bruised.  If you were very bruised after the surgery you may still be swollen from that.  It looks however like you have a little too much fat there.  At 6 months you will know for sure.  If you do, then you will have to consider treatments to try and reduce the fat - ultrasound will often help.  A little massage will help too if there is still some edema.

Can I still be bruised/swollen from Lower eyelid/fat grafting surgery after 3.5 months (photos)

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Appears as you had a perfect take of the fat grafts. thus appears as excess fat is present. I might try drops of KyBella off label.... 

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