Am I a candidate for upper eyelid fat transfer to treat hollowing after steroid use? (Photo)

Question

I developed upper eyelid hollowing due to long term Steroid eyedrop use. In December 2022 I underwent bilateral upper blepharoplasty with fat repositioning. There was not much fat to reposition, so I still have a deep superior Sulcus defect. I will plan to wait one from surgery before pursuing anything. Would a fat transfer be a good idea? Would it be too risky given the proximity of the superior orbital artery?

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. Dermal fillers are likely the best solution for treating this area. These hyaluronic acid formulas can be administered to improve the shape of the eye and reduce the hollow appearance. Though filler treatments are not as invasive as surgery, they do require a great deal of skill and precision to achieve the best possible results. For injections around the eye, a micro-cannula is preferred to minimize bruising and swelling and ensure the smoothest outcome.
I recommend scheduling an in-person consultation with an experienced injector. They will be able to review your medical history, discuss your concerns and goals with you, and help you decide on the best treatment option.

Zoran Potparic, MD · Answer

I do believe that subtle correction of upper eyelid hollowness should be addressed, best with fat grafts. Lower blepharoplasty and fat grafting of the cheeks and periorbital area should be considered as well. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

That part of the body is not a good area to try fat grafting. do you have virtually no post tissue to support the graft which will lead to a high percentage of graft loss with uneven survival and a high chance of lumpy fat necrosis making things worse.
Any contour irregularity will be obvious from across the room.
Facial fat transfer is emphasized, unpredictable and unforgiving in relationship to the use of fillers.
See if you can get a provider to get consistent quality results with Fillers first and foremost before he ever considering that transfer.
 The chance of fat transfer working well and giving you the results you would help far is highly unlikely even if you find the best provider in the world.Getting consistent results with fat grafting requires there be sufficient post tissue to support the graft for the graphs will not survive.
High percentage of graft failure may be acceptable in the areas that have lots of soft tissue to hide the fat in the crosses. that is not the case in Your orbital rim.Fillers are far more forgiving and can be reversed if you don’t like the results.
Personally I would steer you far away from fat transfer for what you’re trying to accomplish.
Best,
Mats Hagstrom MD

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