Lower Eyelid Stain Post Fat Transfer: Hemosiderin or Hyperpigmentation?

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?

Doctor Answers 6

Fat injections and dark eyelid circles

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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.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Lower Eyelid Stain post Fat Transfer

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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.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Hemosiderin Staining After Fat Transfer?

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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. 

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Black eyes and lumps after fat transfer.

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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.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Stain under eyes

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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

Guy Massry, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 54 reviews

Still too early

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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.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.