Fat Vs Skin Grafting for Hollow Eyes After Blepharoplasty?

Hello, I have upper eyelid hollowness from an upper blepharoplasty in 2006. I also have scarring in the left upper inner corner and some shortage of skin in this areas.

One doctor has recommended Fat grafting to upper eyelids while one has recommended a small skin graft to the upper inner corner. Should I do both, and if so, which one should I do first?

Doctor Answers 6

You need a surgeon not a procedure.

Dear Cissy

Without a doubt, you had too much fat and skin removed from the upper eyelids. You need a personal consultation with an eye plastic surgeon who fixes overdone eyelid surgery.

You might benefit from fat grafted into the subbrow area. This is not at all the same thing as giving back your upper eyelid fold. However, it does increase the fullness of the subbrow area softening the harsh appearance.

Fat pearl grafting was our best idea 20 years ago. Some surgeons picked up on this idea and have never moved on. However, fat transfer developed after the technique of fat pearl grafting. Fat transfer is faster and more predictable that fat pearl grafting.

Also, instead of a large incision needed to place the fat pearl, the transfered fat can be injected through a tiny nick in the skin. Fat pearls are large enough that much of the grafted fat dies rather than survives.

Transfered fat is much finer than the pearls and is better able to get a blood supply in the tissues it is placed. This means that more of the fat will survive which translates into fewer revisional surgeries.

Also your upper eyelid appears disinserted and it may be that you would benefit from having this tendon tightened. This can have the effect of opening the eyes, and shortening the upper eyelid platform so that the upper eyelid does not look so long. Together with fat transfer to the eyebrow, these procedures would help soften your appearance.

Regarding a skin graft to the upper eyelid, this is a disfiguring procedure that should be reserved for situations of chronic corneal exposure and breakdown. This type of an assessment can only be performed by a fellowship trained oculoplastic surgeon.

Dr. Steinsapir

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fat Transfer to Hollow Upper Eye Lids

Hi Cissy,

Fat grafting would be the best solution for your problem.  As Dr. Steinsapir advises, the treatment is not a commodity, but a procedure that requires aesthetic sense, experience, and skill.

Choose your treating physician carefully.

Be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Fat Grafting for Hollowness around the Eyes

I would recommend micro fat grafting for the upper eyelid hollowness. If done with expertise I would expect a good softening of your eyelid appearance. Although many patients are satisfied after one session of fat grafting, I always prepare our patients for two treatments in case one wants to see more volume in the respective region.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Seek Oculoplastic Consultation for Ptosis repair.

Dear Cissy,

I see your problem with hollow upper-lids. I've personally corrected this with injectable fillers with overall good (not great) results.

I could be wrong, but check with a board certified ophthalmologist or oculoplastic surgeon to see if you have ptosis (pronounced: "tosis"). Ptosis is a common condition where your eyelids hang too low. This can cause you to see too much of your upper lid skin (instead of just a crease) when your eyes are open. In the right hands, ptosis repair looks completely natural, and may be the best option for you.

Best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Fat grafting

I agree that you do have significant hollowing. The best correction is fat grafting. A small amount of fat is taken from the flanks and then injected under the obicularis muscle of the upper lid. You have nice fullness of the lateral upper lid. There is no fat pocket here. The lacrimal gland is where the fat pocket would be. This is why the lateral lids look good. He didn't remove fat from there. In addition there is the brow fat pad which is a subcutaneous area of fat in the upper lid as well.

See someone for fat grafting. Mind you it may take more than one grafting procedure to correct the problem as fat absorption can be unpredictable.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 33 reviews

Fat versus skin grafting

A skin graft should not be performed unless there is the closure issue with the eyelid. Fat grafting and the skin graft can be performed together at the same time if needed.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 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.