30s male, fat transfer for lifelong tear troughs? (Photos)

I agree that fat transfer is the route to go initially. I have had success with the procedure for 20 years and continue to find it very beneficial, but experience by the practitioner is very beneficial to optimize results. Blepharoplasty with release of the adherent tissues and fat grafting or repositioning can potentially give the very best results but is a much bigger procedure.

Your mid face lax ideal Ford projection. This is causing herniation of your lower eyelid fat pads with progressive weakening of the Peri orbital septum.
Grafting fat in an area that has so little host tissue is a high risk procedure with uneven fat survival.
It’s a risky procedure with a high incidence of hard lumps and uneven contour.
Fillers are far better in regards to being more precise, more predictable and far more forgiving if you don’t like the outcome.
What’s the treatment option if you don’t like the fat grafting results?
The procedure your doctor described is actually ideal and it’s a far better procedure than grafting fat.
Leaving fat with its original blood supply guarantees its viability.
Grafting fat it’s not like putting Bondo on a dented car.
Graft survive based on a multitude of factors which all have to be lined up correctly in order for the procedure to be successful.
First and foremost the area Hass to have sufficient host tissue to support the graft.
Your tear trough is almost completely devoid of soft tissue other than very thin skin right over your facial skeletal structure. What tissue is going to keep the graft alive?
This is a difficult anatomic area to do work in and results need to be very precise or the outcome becomes obvious and visible from across the room.For this type of work do you need to be highly selective of who does the procedure.
I suggest having a minimum of five consultations at which time you should ask each provider to open up their portfolio and show you their entire collection of before and after pictures.
With fat transfer make absolutely sure the after pictures were taken at least three but preferably six months from the date of surgery.
Being shown a handful of preselected pictures which most likely represent the best results of the providers career is totally insufficient to get a clear understanding of what average results look like or how many of these procedures that surgeon has performed.
An experience provider should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures.
Filling the tear trough is maybe not the number one procedure done but it is certainly not uncommon.
A single consultation is insufficient to confirm your in the hands of the ride provider.
You need to not only have multiple consultations but you need to have the skill to vet providers and be able to differentiate who has the skill and experience to get the best and most consistent results.
If you don’t ask providers are going to show you a handful of their best results.
Instead ask providers to show as many pictures as possible of previous patients who have very similar facial characteristics to your own. Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped for.
Ask specifically how many previous patients have had revisions and what the surgeons revision policy is.
Anybody who gets fat grafted in their face or body needs to contemplate how that tissue is going to be removed if you don’t like the outcome.
Grafting fat in this part of the face is unpredictable, imprecise and to some degree unforgiving.
Dead fat that forms firm nodules of fat necrosis become obvious just like light throws shadows on your current problem.
Patient considering grafting fat have to also be excepting of managing grafting sessions that don’t turn out the way they had hoped.
Grafting and this part of the face is not easy and straightforward.
Fillers on the other hand are highly predictable, very precise and extremely forgiving.
The use of fillers and a quality lower eyelid blepharoplasty would be a far safer and predictable way to go but obviously lacks permanency. with the exception of the lower eyelid blepharoplasty.
The primary problem is related to the lack of projection of your maxilla.
The bone structure leads to soft tissue issues.
Do yourself a favor and schedule more consultations than you think you need before committing to permanent and potentially irreversible operations.
Best,
Mats Hagstrom MD