Lumps After Upper and Lower Eyelid Fat Injections

Question

I had fat injections to upper and lower eyelids (for hollow eyes) in the middle of December. A week afterward, I noticed lumps forming which have not entirely gone way. The improvement on the upper eyelids and brows is minimal. The doctor said I need a second injection scheduled for the beginning of April, even though he origianlly said to wait 6 months. I am concerned about possible injuries, smoothness, and spending a lot of money for minimal results. What are your thoughts?

Brent Moelleken, MD · Answer

If you have permanent lumpiness from the first procedure, it is possible that another round of injection might not only not fix the problem, but could possibly make it worse.
No doubt your doctor has gone over that with you, and is a board certified plastic surgeon familiar with eyelid surgery, and treating its complications as well.

David Shafer, MD, FACS · Answer

Sandye,
If you had problems with your first surgery, I would be cautious about having another similar procedure.  It would be best to wait as you had originally planned to let all the swelling resolve and the tissues settle.  Also, if you are concerned, it may be best to get a second opinion.  Good luck.

Michael Law, MD · Answer

There should not be lumps present after fat grafting.  I regularly perform fat grafting for hollows under the eyes and in the upper eyelid / brow area where people can have hollows. The correction of eye hollows can make an incredible difference in ones appearance. It is the kind of result that make people notice youthfulness and attractiveness without being able to put their finger on  what has changed

Steven Wallach, MD · Answer

Fat injections can be very satisfying interms of long lasting resutls around the eyes. I think it is best in the eyebrow region but can be difficult to camouflage along the lower lid. I prefer the absorbable injectables for that lower region just for the reasons that you complained about.

D.J. Verret, MD · Answer

I would express caution with a repeat injection of fat inside of six months. While lumpiness is always a concern, if the fat is injected in the proper plane (deep to the muscle) and in microdroplets, lumpiness is generally not a problem. I also advise patients to wait six months between injections because there is the possibility of swelling and other abnormalities which need to settle before another cosmetic injection is undertaken.

Samir Shureih, MD · Answer

To see and feel lumpiness after fat transfer is because the fat was injected in a large clump, or very superficial.
In the eye lis the fat should be done as a MICRO fat transfer, the fat is liosuctioned with a very small canula, and injected deep to the muscle with a very small canula.
The fat is deposited in small pearls in a fan shape manner to avoid the lumpiness. You can repaeat fat transfer after 12 weeks safely by then all inflamatory healing is over and the fat is stable.
The lumpiness will be difficult to coumaflage by injecting more fat. you may have to surgically remove the lumps which is difficult as well, but can be done.
Fat transfer to the face can rejuvanate the face including the brows, lids naso-labial folds and the cheeks and chin.

Hisham Seify, MD, PhD, FACS · Answer

it is important to be very careful with fat injection around the eyes. The key in this location is very small amounts and as deep as possible. If you see lumps early they could be massaged down. I rather not use local steroids as the results could be unpredicable. hope that helps

Jonathan Hoenig, MD · Answer

I have been doing fat injections (fat transfer) for close to 10 years around the eyes and unfortunately, a large part of my practice involves correcting bad fat transfer.  There are several reasons why you might have noticeable lumpiness under your eyes after fat transfer. The two most likely reasons are:
1. It was not put in properly. Not placing it deep enough or large amounts in one area will cause the fat to be lumpy and/or visible.
2. Your tissues are too thin to cover the fat.
Restylane is a good option for people wanting added fullness or correction of hollows under the eyes. About half of the people that come to me wanting fat end up with Restylane because I'm afraid that in them, the fat may be visible. The ones that are good candidates for fat transfer and do have it are thrilled.
Now that you already have lumpiness, I suggest that you consider either a different surgeon or a different approach. The correct solution for you will depend on the reason that you have lumps. The options are: fill in around the fat with Restylane to smoothe the contour, remove the fat and put it in correctly (assuming your skin is thick enough), or add more fat without removing.
If you have a bulge of lower eyelid fat (not transplanted fat) and an area of hollowness beneath it, then you could reposition the fat.
Good luck!

Brooke R. Seckel, MD, FACS (retired) · Answer

Sandye,
I do not inject fat or fillers around the eyes because visible lumps beneath the eyelid skin and permanent discoloration happens with an alarming frequency. Check previous questions about filler injections around the eyes and fat injection eye problems on Realself and the internet-it should give you pause.
To correct hollow eyes and dark circles under the eyes I place a composite fat graft under direct vision through a tiny laser incision placed on the inside pink portion of the eyelid.
I suggest you do an internet search on hollow eyes and laser correction of dark circles under the eyes to learn more about new techniques.
Massage may help soften the lumps and increase resorption of the fat.
After having lumps the first time I would discourage you from having further injections of any kind around your eyes.
If you want to correct hollow eyes or dark circles, a transconjunctival arcus marginalis release and fat grafting is the appropriate surgical procedure.
You can see before and after pictures of composite fat grafting results for removal of dark circles.

Lumps After Upper and Lower Eyelid Fat Injections

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