Too much fat was removed from lower eyelids. How to fix this?

Hi, At about 2.5 years eye surgery ( acculift) after that i havent blepharoplasty my eyes just looked horrible very hollow. What can I do? It is possible to put it fat back for lower eyelids? Which procedure is better pearl fat grafting , microfat transfer, structural fat grafting? Has anyone have experience?

Doctor Answers 4


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Fat can be placed back to fill a hollow in the lower lids as can various fillers. Photos would be helpful to see what you are trying to accomplish.

Lower Eyelids Hollowed Out After Fat Removal Blepharoplasty

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Having already had excessive fat removed from your lower eyelids puts you in a difficult place. The fat that was removed is called orbital fat and it cannot be replaced. This is special fat that is continuous with the fat that fills the eye socket and holds your eye in position. This fat is special in that it is not affected by changes in your weight. If it were, your eyes would bulge out if you gained weight or they would sink back into your head when you lose weight.

The procedures to fill the lower eyelid are not able to position the fat in that same location. Some correction of your problem is possible, however. Fat grafting may work but I find that the failure rate (fat does not survive and resorbs) is too high (around 50%). Furthermore, it is not readily reversible and would plump up with gains in weight and shrink down with weight loss. I use tear-trough implants while simultaneously blending the protruding orbital fat into the cheek. The bag goes away and the cheek is a bit fuller close to the eye and blends into the eyelid. The soft tissues of the cheek stay the same as far as how they move and don't crowd or bunch as can happen with fat or Restylane.

Restoring lid-cheek transition

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There are both surgical and nonsurgical options to correct this. Non-surgically, hyaluronic acid fillers such as Restylane and Belotero are excellent options. They can be performed in the office in under 30 minutes with minimal downtime. Unfortunately they are temporary and last 9-12 months.

Surgically, multi-level fat grafting provides excellent permanent results. The amount of fat that remains viable varies from patient to patient, so it is possible to need additional volume replacement down the line (fat grafting or hyaluronic acid filler).

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

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You can use either fillers of fat to help this.

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When too much fat is excised in a lower eyelid surgery, you can develop a hollow appearance. You can try a hyaluronic acid filler, and I usually use restylane or belotero for this. If you like the way your lids look with some filler, you should think about doing a fat transfer to this area. If done correctly, you should get a great result. Make sure you go to a surgeon with experience in fat grafting to this area.

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.