Lower Eyelid Stain Post Fat Transfer: Hemosiderin or Hyperpigmentation?

Question

I am just about a month out of a horrible lower fat transfer to my lower eyes that has left my right eye lumpy and bumpy, and my left eye still hollow in the outside but most disturbing, under the eye is still stained with a reddish purple ring giving me raccoon eye (which is why I had the FT to begin with!).

	30 days later.. is this hemosiderin? is it still bruising? is it hyperpigmentation? My plastic surgeon has me on hydroquinone but I wonder if a pulse dye laser can help this?

Harold J. Kaplan, MD · Answer

Hi Rockdude.  To determine the best course of action, we would need to see you in person.  The reason is that it is hard to tell from the photo whether the issue is more pigmentation or a vascular (healing) response. 

	Ultimately, the q-switched Nd:Yg laser is excellent for pigmented issues and the Cynosure V-Star is great for vascular issues.  It's likely we would use one of those two.  Finally, we normally wait more than one month to take on a case like yours.  If it has been less than 6 months since surgery, we require that your surgeon consent to laser treatments.

Ron Shelton, MD · Answer

You would need a physical exam to try to discern the cause for the coloration. It is very rare on the face to have hemosiderin staining. Bruises typically resolve on the face before 3 weeks. Vascular congestion can cause some bluish-red discoloration in some people, but postinflammatory hyperpigmentation is more common, especially in skin of color, Asian and Mediterranean skin. Periocular familial hyperpigmentation is a discoloration from excessive melanin that someone inherits. If the fat injections had created a nice elimination of hollowness of the lower eyelid but the skin still appears dark, it may be epidermal or dermal pigment that no filler will help. In that case, multiple treatments including peels, lasers and topical agents might help, although there is a risk of post-inflammatory hyperpigmentation with some treatments.

Toby Mayer, MD · Answer

Black eyes and lumps after fat transfer are often seen in dark skin patients due to hemosiderin. Time is what you need not a laser.

Guy Massry, MD · Answer

The photo is dark so hard to tell for sure. I would allow swelling to resolve before any intervention. Lasers can be of benefit. In addition I have had success with IPL treatment. As there is no obvious bruise I would give it a bit more time before further treatment (except meds for swelling). I know this is bothersome but sometimes patience and time are the best treatment options

A.J. Amadi, MD · Answer

Based on the photos, this could be residual bruising evolving into hemosiderin staining. This can improve over many months, so I would not recommend any type of laser at this time.

Lower Eyelid Stain Post Fat Transfer: Hemosiderin or Hyperpigmentation?

Answers (6)