Fat Grafting Behind Eyeballs to Lessen Hollowing?

Can fat grafting be done behind the eye to give a more protruding look of the eyeball, and create a less hollow or sunken look?

Doctor Answers 10

Fat grafting to correct upper eyelid hollows

Fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes. I often perform fat grafting in the upper eyelid area to fill in hollows that occur from age, genetics or previous eyelid surgery.
Too often upper blepharoplasty leaves patients with upper eye hollows. The next time you flip through a fashion magazine, 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 means 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.
Fat grafting works by expertly injecting very small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
Fat Grafting requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements are possible

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 reviews

Risk of fat grafting behind the eyelid

A hollow appearance can result when the eyes are deep set. This results from a relatlively large orbital socket vs. the volume inside it.

In traumatic cases, the volume can be enhanced with placement of tissue inside the orbital socket, to allow the globe to sit more forward. In thyroid patients when the eye is overly prominent, the opposite can be done.

These procedures all have very significant risk of injury to the optic nerve, the only nerve that goes to the eye. Disruption through bleeding will cause blindness.

Needless to say, this is not a common cosmetic procedure for this reason. Unless the deformity is severe (i.e. from an accident), and the surgeon performing the work is a craniofacial surgeon, it is not recommended.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Grafting behind the eyes is very risky

When people sustain significant orbital trauma, they occasionally develop a condition called enophthalmos in which the eyeball sits too far back or down in the bony eye socket. This can be improved by bone grafting behind the eyeball to push it back up and out. This is major craniofacial surgery and should only be done by extremely experienced and highly trained plastic surgeons who specialize in that kind of work. The major risk of this is blindness so I can't imagine anyone would be willing to perform this on you for cosmetic purposes.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Treatments for enopthalmos

Thanks for the question.

Eyes that are sunken in the the orbits can be described as enopthalmos.The anterior projection of the eye is usually measured relative to the outer edge of the orbit, the orbital rim, but can also be assessed relative to the maxillary prominences, or the contralateral eye.

There are congenital causes of enopthalmos but the most common reason is from trauma (orbital blow out fractures).

Fat grafting is not a technique that is typically used. For patients that have significant orbital volume the orbit itself can be reshaped by cutting the bones that comprise the orbit or layering additional bone or titanium plates to decrease the volume. These are serious operations with the rare risks including blindness or impairment of the movement of occular muscles. Again, usually, patients needing these treatments have experienced facial trauma or have congenital facial bone defects.

You should see a board certified plastic surgeon for a complete evaluation.

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Injection of Fat Into the Eye is Not A Good Idea

Injecting fat into the eye socket to correct a retruded eye or enophthalmos is not a good idea. As noted, this can be due to many conditions and may be your natural appearance. A better approach is to either correct the underlying abnormality or prop up the eye with an orbital implant. For purely cosmetic reasons, these surgeries should be avoided as they can have serious side effects including vision loss.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
3.9 out of 5 stars 14 reviews

Fat Grafting to the extreme!

If you look hollow or sunken, then fill the hollow or sunken area, do not push the eyeball out any further. More importantly, adding fat behind the eye is extremely dangerous and undesirable for a cosmetic procedure.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Fat grafting should not be done behind the eyeballs

Fat grafting is an extremely effective and powerful technique to recontour the area around the eyes. Fat may be safely ejected around the sides of the eyes and in both the upper and lower eyelids. This may be sufficient to give your eyes a fuller appearance area however, fat should never be injected behind the eyeballs because this area carries extreme risk of damage to the optic nerve and result in blindness. When considering such procedure, it is essential that you work with a board-certified plastic surgeon who is a great deal of experience not only with fat grafting but with blepharoplasty and brow lift procedures. Such a surgeon will be most qualified to explain what combination of search is you need to obtain the result you want.

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 108 reviews

A frame deformity and microfat grafting

Having sunken eye balls could be post surgical,post trauma or just idiopathic and present since bith. When it is due to having less fat in the uuper part of the eye socket,it is referred to as the A frame deformity. Augmenting the orbit is done in trauma cases as previously described by my collegues. However ,changing the A frame deformity is possible with microfat grafting. It is a very techincal procedure and requires a lot of finesse in order to avoid critical structures. Hope that helps!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Fat grafting behind the eyes is tricky


If you've had a sunken appearance of your eyes for most of your life and not as a result of aging or previous fat removal, perhaps indeed you'd benefit from contouring the bones around the eye socket. Fat grafting the socket itselft (behind the eyes) is pretty tricky and probably best avoided.

You'll get your best recommendation from a plastic surgeon who does a fair amount of bone work on the facial skeleton. Get their advice and go from there.

Brian K. Brzowski, MD, FACS
Ogden Plastic Surgeon
5.0 out of 5 stars 76 reviews

Fat grafting behind eyes not a good idea

Your request is a bit unusual. Injecting fat behind the eye is not a good idea. If you are referring to enophthalmos, this is often due to facial fractures. And yes, if there was a facial fracture, reduction of the fracture, and sometimes grafting either autologous tissue ( i.e bone) or synthetic permanent material is usually recommended. Injecting fat behind the eye itself may lead to disastrous, if not permanent, catastrophic loss of vision due to complications.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

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