Dr. Seckel's open composite fat grafting vs. standard fat injections

This technique has been around for about 10 years and most oculoplastic surgeons will be familiar with it, if not actually experienced in it. It is an excellent technique in the right patient [mild-moderate fat prolapse].

You are correct in that it has a much lower chance of causing uneven lumpiness.

Riz19080,

Thank you for your question. Your experience with fillers is very common and I rarely use them. Most often the filler is placed improperly or the function of the eyelid muscle displaces the filler out of the eyelid depression and makes the dark circle worse.

Fat Repositioning mentioned below in which the fat is left attached to the vessel is not new, has been done for many years most notably by Dr. Pat Maxwell in Rhode Island.

I abandoned Fat Repositioning 10 years ago because the blood vessel attachments retracted the fat back into the orbit out of the Dark Circle and lost the correction. Dr Maxwell handles this by suturing the Fat into the depression, however in my experience sutures in this area can create visible skin depressions on the outside.

In addition, most people with Dark Circles Under The Eyes can benefit from additional fat being placed into the region below the lower Eyelid also called the Nasojugal Fold or Arcus Deformity.

To reposition the Eyelid Fat down into the Dark Circle can make the lower eyelid look hollow. Therefore in many cases I leave the normal Eyelid Fat in its normal position and add a Composite Fat Graft into the depression beneath the lower eyelid that is causing the Dark Circle.

Harvesting additional fat from beneath the pubic hair and placing it as a composite graft plumps the Dark Circle and rejuvenates the upper cheek-a double benefit.

I also frequently add a "pinch Blepharoplasty" to tighten the lower eyelid.

I avoid Fat Injections not so much for fear of fat loss as concern about damaging delicate eyelid structures by repeated needle injections into this important area.

There are a number of variations of the technique you described.  One of the newer variations is by Dr. David Hidalgo who performs the same release of the arcus marginalis but instead of placing a piece of fat into the hollow, he transposes fat from the lower eyelid over the infraorbital rim and secures it in place.  Because this fat still has a blood supply, survival and predictability is better than placing a free fat graft into the site.

For the right patient, these techniques perform very well but still in some patients who have not only hollowing in the tear trough of the lower lid but also deflation of the medial-central fat pocket of the mid-face, a fat transfer or other filler is necessary to ensure a smooth, crease-free transition from the lower eyelid on to the mid-face/cheek junction.

Please consult with a plastic surgeon who is well versed in these techniques and based on your examination can select the best options for you.