I had upper and lower eyelid surgery 7 years ago. It left my eyes hollowed with dark circles and sunken lids. My eyes are no longer almond-shaped and they won't stay closed during sleep (I can blink). I had fat grafting, and it did make a difference. Should I have more fat transfer treatments? Will I ever have the almond shape for my eyes again? What other options do I have for corrections, and what should I expect for the results? I'm planning to go on consultations in Florida and I want to approach them with the proper questions.
Fat Transfer for Correcting Eyelid Surgery Results?
Doctor Answers 6
Fat transfer is not a good solution for this set of problems.
I think you have to be very careful what you look for. Your lower eyelids have been damaged by your prior eyelid surgery. The skin is thin. Transfered fat will not hide well under this skin. There are a number of approaches to help this area. These also include filling the lower eyelid area with Restylane. However reshaping the eyes to recreate the almond shape requires the placement of a hard palate graft. In Florida there is essentially only one surgeon I would be comfortable referring you to for this type of issue and that would be Dr Michael Patipa. I think that would should seriously consider seeing a few post-cosmetic eyelid surgery reconstruction specialists. There are several of us in Los Angeles but it is a rare set of skills.
Canthoplasty/pexy not more fat grafting required to restore eyelid shape after Blepharoplasty
My concern is that fiurther fat grafting may worsen your eyelid droop. A canthoplasty or canthopexy is the appropriate procedure to correct ectropion or scleral show and attempt to restore the almond eyelid shape.
Fat Transfer For Correcting Results from Eyelid Surgery
I regularly perform fat grafting for patients who have had too much fat removed during blepharoplasty. Several examples of these images are available on my website.
There really are no ‘shortcuts’ that a surgeon can take when performing fat grafting surgery. Every step in the process must be performed with great attention to detail. Make sure that the surgeon you choose provides some description of their fat grafting technique, provides some indication of their level of experience with fat grafting, and demonstrates to you a high level of success in terms of fat survival and natural-appearing results as represented by ‘before and after’ photography.
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It is difficult to tell from your photos whether or not you have scleral show or rounded canthi. If this is the case, a canthopexy may be necessary to lift the corner so your eyes and give you the almond shape that you are missing. Fat grafting is good to fill out the upper lid region to remove some of the hollowness that can be created from over excision. Not being able to close your eyes completely is not a good thing.
Revision eyelid surgery.
Eyelid surgery is tricky, and unfortunately we see quite a few problems like yours. Before any further fat injections (and I am a big believer in fat injections), you need a canthopexy to lift the outer corners of your eyes. This should restore the almond shape.
You need a real specialist. Try an oculoplastic surgeon.
Secondary eyelid procedure
Dear Vickie Sue,
It sounds as though you have 2 discrete issues to address. The first is loss of the almond shape of your eyes. From your photo, it looks as though you have bowing of the lateral one-third of the lower eyelids. It's hard to know the exact procedure you need to correct this without examining you, but you need some type of lower eyelid tightening - either a canthpexy or a canthoplasty. With a canthopexy, the outer portion of the eyelid is tightened without detaching it from it's current location, whereas with a canthoplasty, the eyelid is disinserted, shortened, and re-attached higher and further back. Both are highly effective procedures and can help restore the almond shape to your eyes.
The second issue you describe is hollowing out of your lower eyelids. Fat transfer can be quite effective is restoring volume to the lower eyelids. Just make sure the surgeon you choose has experience with doing this, as superficial placement of fat or transfer of larger globules of fat can lead to a lumpy appearance.
Hope this helps. Best of luck.