Can Eye Bags from Fat Transfer Be Corrected Through Blepharoplasty?

Tuscany
Regarding the dark circles - filling the depressions under the eyes does not normally correct these circles unless they are created by shadows.
Regarding the bags - The most important information needed to correct your problem (under eye bags and lumps) is to determine exactly where the fat was injected. If the fat was injected into the sub-dermal or SOOF spaces a transconjunctival blepharoplasty would not be the best approach. If the fat was injected below the orbital septum, then a transconjunctival approach would work fine. If the injections were in both in front of and behind the orbital septum, I would prefer the sub-ciliary incision allowing easier access to all spaces.

 

Your bags may be festoons (swelling of the upper cheeks) which can sometimes occur after fat injections.  This is typically temporary and can sometimes respond to dilute steroid injections.

Tuscany,
I would not rush in too quickly to try and remove fat as that can cause more swelling. For the next three months you should massage the lumps as this can often redistribute the fat. If there are specific lumps after 6 months, then they can be reduced with transconjunctival fat removal, usually in an easy procedure. Fat transfer under the eyes can be a very rewarding procedure, so a surgeon with an extensive experience in these injections should be sought out. Good luck.
Dr. Miller

Tuscany, Operations around the eye can be complicated, especially if you have already had other procedures affecting the tissues (fat grafting / injectables). You can likely be helped, but it is important that you go to someone with experience. It would help if you would post a picture so we could give you more specific advice.

Lumpiness after fat injection can occur at a different anatomic place than fat reached by blepharoplasty, so the method of removal will depend on exactly where the fat is. While it is possible a blepharoplasty might correct the problem, it is also possible that the fat is located below the skin, underneath the muscle and not the usual place of below the orbital septum.
The skill level for treating this problem is much greater than for a typical transconjunctival blepharoplasty.

1.  I would return to your surgeon for advice.
2.  Yes, the fat can be removed, but it may require a traditional blepharoplasty incision rather than a trans conjunctival.
3.  There may be an argument for leaving well enough alone, depending on the severity of your concerns.

Dear Tuscany,
Fat transfer can be a fantastic procedure. However, it is very difficult to use in the lower eye lid due to lack of soft tissue coverage. In the cheek or other parts of the face, transfered fat is hidden by the subcutaneous fat. In the lower eyelid, there is essentially no lower eyelid fat. Transfered fat can easily form lumps that present as irregular fullness in the lower eyelid.
The situation you are experiencing may or may not benefit from transconjunctival lower blepharoplasty. One problem that I often encounter when trying to correct a lower eyelid fat transfer ( Its worth emphasizing that these are individuals who have had surgery else where and then seek me out for help.) is that the lumps of fat are not in just one place. Lower eyelid fat creating fullness lives behind the orbital septum and it is always in the same anatomic locations. Transfered fat sits in numerous planes. Its removal is therefore anything but straight forward. Occasionally I will use restylane to fill around the existing lumps of fat.
I would encourage you to consider a consultation with an eye plastic surgeon to assess your situation. I would be very careful regarding the proposed plan for surgical revision. Also, steroid injections are not very predictable but occasionally these can be used to atrophy some of the grafted fat. Good luck with your issue.

There are several ways to correct excess fat in the lower eyelids after fat grafting in this area. Your surgeon may elect to remove these fat bags through a blepharoplasty if they are of significant size. Your surgeon may also elect to perform a small excision and remove this fat directly. If the bags are of minimal size, it may be possible to inject the medication into this fatty area to encourage it to melt away on its own.
 

The bags under the eyes at age of 25 are probably more related to allergies and/or hereditary pigmentation issues. As there is very little fat present in the lower eyelids at this age, it is very difficult to remove any fat that has been placed in the orbital sockets completely. Bags underneath the eyelids are all caused by fat in three little compartments that can be teased out through a transconjunctival approach if they are causing a noticeable cosmetic bulge.

Tough question. It is hard to tell without examining you. But, some of the bags you are complaining about may be residual swelling. If you have lumps from the fat injections, you might want to remove the fat directly through very small incisions on the lower lid. Dark circles are usually either shadows or due to the visualization of the muscle through the thin skin. Some have tried hydroquinone to bleach the skin, but most of the time that doesn't work especially if it is from the muscle.