Fat Graft Removal on Upper Eyelids

The eyes are the primary facial feature that communicates tiredness or exhaustion (and, likewise, energy and vitality). Your cheeks and your neck don't really reflect whether or not you've had a good night's rest. But miss a night of sleep and your eyes will make it obvious to everyone.

Aesthetic plastic surgery of the eyelids can produce a dramatic rejuvenating effect, literally taking years off of a person's appearance. Interestingly, many patients find that following eyelid surgery friends will say 'You look great!', but they usually cannot pinpoint exactly why.

Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed.

As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.

Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume can dramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery - it just looks youthful.

In some individuals the upper lids appear heavy and 'droopy' because of descent of the lateral brow. A lateral browlift can reduce or even eliminate the need for excision of upper eyelid skin in patients with lateral brow descent.

Fat grafting is extremely effective and powerful technique to recontour and rejuvenate the face. It is possible that after such a surgery, you may notice a small amount of extra fat in certain areas. Keep in mind that whenever we transfer fat from one part of the body to another approximately 20% of it will melt away on its own. For this reason, surgeons commonly add a little bit more fat than we want to remain. Your best bet is to wait at least 6 to 8 months to allow the healing process to complete before assessing the final result. If you still feel that the area is too full, it is possible to remove the excess fat with a small incision and direct excision of the fat or where the injection of a medication that will help the fat contract and shrink.
 

Cissy,
Is the ptosis the result of your fat graft? Was your fat graft done by injection or by open fat grafting through an incision?
I am assuming that you have a visible lump caused by fat grafting into the upper eyelid-possibly done by needle injection. These fat grafts can be removed surgically very simply through a small incision-I use a laser- placed in the skin of the upper eyelid.
If your graft is recent, I would simply massage the graft and wait 3-4 months for the graft to dissolve-then yoiu may not need surgery.
I would be happy to review your photos if you email them to me and I can give you a better recommendation. I am most concerned about your ptosis.