Had Problems with Fat Transfer?

Question

I was originally interested in Blepharoplasty, but my surgeon said I didn't have excess skin, and what I really needed was more volume, so I opted for fat transfer instead.  I had a mini-face lift, brow lift, and under eye fat transfer. I am now 2 weeks post op and have a ridge of puffiness under both eyes just above my cheekbone. They give me the appearance of bags under my eyes.  I understand that 2 weeks is early, but I guess what I'd like to know is: are there more people who experience problems with this procedure compared to those who have a successful outcome? Is it normal to have puffiness or swelling.  It has become softer in the past week, but I can still hardly stand to look at it.  It's all I see, and the success of the brow lift and face lift are overshadowed by those bags.

David Shafer, MD, FACS · Answer

Lucinda,
You are still early after surgery.  Fat grafting tends to swell - in some people very dramatically.  However, after a few weeks, the swelling resolves and you will likely be pleasantly surprised.
That said, for other people reading this, please be very careful before you let anyone inject anything around your eyes.  The skin is very thin here and sometimes overzealous or  misplaced injections are not correctable.
I hope this is helpful.

Brent Moelleken, MD · Answer

Since you are just two weeks postop, this is very early indeed to be assessing the results of your surgery.
Fat grafts contain partially live tissue and partially dead tissue.  During the healing process, blood supply and therefore swelling is increased.  The dead fat is being resorbed and the live fat is being healed by new blood vessels.  All these processes yield swelling, so swelling early after surgery is not only normal but expected.
You should communicate closely with your surgeon to determine the timepoint where injections, massage may be indicated.
Long term, direct removal of the fat grafts is often the best way to solve this problem, but that typically wouldn't occur until 6 months postop.

Steven Wallach, MD · Answer

Give it some time.  The swelling may be due to the  fat injections themselves.  As long as it is not lumpy you probably will be ok.

Hisham Seify, MD, PhD, FACS · Answer

The use of micro fat injection in the area of the tear trough and to camouflage lower lid/cheek problems is a valid alternative to lower blepharoplasty. However, this is a very technical procedure that requires accurate placement of the fat transfer.
We looked into a series of 100 patients (1) who underwent this technique and found that it is a good technique in patients with mild deformity or previous surgery with no skin excess. An under correction is always better then an overcorrection.
(1) The Use of Micro fat Grafting in Periorbital Rejuvenation: Review of 100 Consecutive Facelifts: 24. Hisham Seify, MD; T Roderick Hester, MD Sep 1, 2005 PRS
You are still early after surgery the following could be very helpful:
1- Lymphatic massage might help to distribute this excess fat over a larger area.
2-Kenolog injection (dilute steroids) might help but must be used very careful as it could cause skin atrophy and pigmentation.
3-If all this fails an open surgical excision could address the problem.
I hope this will help!

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