Correct Bad Fat Transfer Results with Blepharoplasty?

If your surgery was six months ago and things have reached a plateau, it is likely that you have a stable problem. The problem is how to treat it.
Firm lumpiness from fat injection to the lower eyelids is a common problem. In my experience it is usually necessary to remove the fat injection lumps directly. This is a tricky proposition, to say the least, because the lumps can be in all layers of the lower eyelid, from the epiperiosteal layer to the shallow subcutaneous layer, with the orbital septum and the orbicularis muscle in the middle.
Often, correction of the problem will involve midface elevation through a cheeklift, canthal restoration to support the amount of work to be done on the different layers, direct removal of fibrous fat injection tissues, possibly placement of new grafts. In our practice we typically use nontraumatized autologous fat fascial grafts (LiveFill) placed precisely, usually in the eye-cheek junction or the tear trough region. Or sometimes lumpy fat injection grafts can be removed directly through a transconjunctival approach or directly through the skin through tiny incisions, it all depends.
A traditional blepharoplasty usually involves reduction in fat from the lower eyelid, which would not typically deal with the fat injection lumps.
Your case underscores two points. First is that the lower eyelid is an unforgiving anatomic area. Second is that patients should have great caution before undergoing even seemingly minor procedures such as fat injection to the lower eyelid.
It never hurts to seek several opinions from plastic surgeons with special interest in the midface (i.e. cheeklifts, revision lower blepharoplasty) before proceeding with this next very critical step.

  Yes.  This is an option for you.  It will require marking of the fat lumps and tedious dissection and patience by your surgeon.  There is no right time to do this but at 6 months, I think you have been sufficiently patient for improvement.  I would seek out an oculofacial surgeon listed by ASOPRS.

Fat transfer is a well established method of restoring volume to the face. The amount of fat survival depends on technique of harvest and injection. Technical considerations may affect volume loss, symmetry, and need for further revision.
The advice of your surgeon on the fat transfer should be heeded. Nodules arising from fat necrosis may ultimately subside or may remain permanently. If your surgeon believes they will remain permanently, the best option may be to surgically excise the lesions with a blepharoplasty type incision. Be advised that there are inherent risks associated with a surgical approach including assymetry, scar tissue, eyelid retraction, unsatisfactory results, and need for further surgery. An experienced blepharoplasty surgeon is advised.

Hi Luis,
Sorry to hear about your ordeal. I can imagine how scared and anxious you must be.
The most important thing for you to do now is to follow your post-operative instructions and stay in close touch with your treating surgeon. Panicking and searching the web two days after eye lid surgery will not help in your recovery at all. There is nothing to do at this point but heal as well as you can. Your surgeon should be able to tell you how he/she feels the operation went.
As you can see in the other answers here, after 6 months, blepharoplasty is a method of addressing lumps after fat transfer.
After a few months, if there is still a problem, then return to your surgeon for an answer, or if you prefer, consult with the best opthalmoplastic surgeon that you can find.
Try to relax, turn off the computer, and be patient. I hope that all goes well and that you heal beautifully. Be well.
Dr. P

I think Dr. Wallach thought your surgery was two days previous and if that were the case I completely agree with his assessment. However, if you had fat transfer 6 months ago then you may have issues with the fat not surviving or scar tissue forming where the fat transfer was attempted.
The lower lid and area below the lids is one of the more delicate places on your body and small amount of tissue can make a big difference. When I was in training at Yale University, we had a professor who had spent considerable time analyzing this area and the best way to restore a "hollowed out" look. He correctly concluded that in lower lid blephs when people remove fat, it tends to make people look more gaunt and that the problem is that fat in that area has descended and can be restored by positioning it at a level consistent with its position when you were younger.
The difference between fat transfer and this technique is you're not devascularizing (cutting of the blood supply) to the fat you're moving so it is more reliable and produces a more predictable result (critical in an area where the skin is so thin). In addition - you may have needed a procedure to tighten the skin of your lower lids to begin with and it is possible the fat transfer has emphasized this need. It is difficult to suggest specifically what you should do without a close examination but at 6 months out I think it is likely that you should consider a revision to improve the look of the lower lids.
I hope this helps.
Steven Williams, MD