Lower Eyelid Stain Post Fat Transfer: Hemosiderin or Hyperpigmentation?

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. 

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.

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.

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

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.

The stain is probably secondary to hemosiderin. Wait another 3-4 months to determine if this is resolving. At that time you can consider laser treatments and decide if it will be necessary to correct the irregularity of the lower lids you describe.