Fat Transfer for Under Eye Hollowness Following Lower Bleph?

Six months following a lower bleph I have developed hollows on the outside corners of my eyes. The area is the actual fat pads right under my rims and not the tear trough and is starting to cast dark shadows. Can this area be filled? Injection or open? I am devastated and don't want to make another mistake. How long should I wait, and I would appreciated knowing who is very experienced with fat transfer in the undereye region. I live in the northeast, but would consider travel. Other options?

Doctor Answers 9

Hollow Eye After Blepharoplasty - Composite Fat Grafting Best

Thank you for your important question. Hollow Eye after Blepharoplasty is caused by the removal of too much fat during the Blepharoplasty operation.

Hollow Eye after Blepharoplasty is different from Dark Circles Under Eyes. The fat is missing from deeper in the orbit-the bony cavity that supports the eye ball.

Fat must be placed into the orbit beneath the eye ball.

Needle injection of filler or fat into the orbit is risky in my opinion and results are unreliable.

I use a Composite Fat Graft, a whole piece of fat harvested from the pubic area and transplant the fat into the orbit under direct vision. This is more accurate and the Composite Fat Graft has a better chance of survival than injected fat.

Needle injection, filler or fat transfer, is a blind procedure placing a sharp needle into a very delicate area, which I consider risky.

Filler injections into the eyelid have caused blindness in a reported case from England.

Correctling hollow lower eyelids with fat grafting

Lower lid hollowness following an overly aggressive lower blepharoplasty can be improved by means of fat grafting. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.

Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 reviews

Under Eye Hollows

With aging some of the fat that normally cushens the eye drops forward causing slight swellings under the eye.  The blepharoplasty involves carefully removing some of this fat to help flatten the area between the lash line and the bony rim. 

This isn't the only problem with aging, however.  As the check fullness falls it pulls on the eye complex worsening the contours that have developed.  With that said, removing the fat is only part of the solution.  Revolumizing  the indendations under the eye and check are also important to restoring a youthful eye area.


Fillers can be used in this area but my personal preference is fat.  Fillers under thin skin are sometimes more noticable and multiple injections are needed because it absorbs. Fat lasts longer and is quite natural in this area.  Talk this over with your physician.  Hope this helps!

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
4.8 out of 5 stars 46 reviews

Fat or filler

FOr the area of concern you describe, there are two options fat or filler [restylane/juverderm], depending on your preference. The upside to fat is that it is permanent [once the initial 40-50% has resorbed which happens by three months]. The downside is that it is much less forgiving and technique is very important because reverse is not easy.

With fillers, it is much more forgiving: it can be molded, and it can also be easily removed if you are unhappy with results. The downside is that it is not permanent and can last as little as 6 months, but sometimes up to a year or two.

It is your choice and your surgeon's preference in which technique they are more comfortable with.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Re-rejuvenation with non surgical blepharoplasty (FAMI)

The classical blephorplasty remove the orbital fat needed to support the eye ball and generally skin and Orbicularis muscle which seem in excess.

To rejuvenate the eye region the good treatment is the bone receding restoration and the injection of the SOOF (Sub-Orbicularis Oculii Fat pad) with adipose extracts (SVF=adipose vascular fraction). When surgical bleph has been done, the resection of the skin, muscle and fat has made the eye region more aged! Therefore, the solution for your problem now is to restore the bony rim, the SOOF and give back the almond shape of the eye aperture by non surgical blepharoplasty described 14 years ago and applied on more than 900 patients documented under the name of FAMI Technique. Ask some surgeons in your County about this incredible procedure.

Roger Amar, MD
London Plastic Surgeon
4.6 out of 5 stars 5 reviews

Under eye fillers after blepharoplasty

Dear Anxious,

-You have 2 good options (in my experience), surgical and non surgical

-If it is just the outside part of the eye socket, it usually does not take much to fill this area out

-Restylane is a great non surgical way to fill it out and results can last 1-2 years

-If you want something more permanent, a fat transfer is a great natural looking filler

-If you have ever considered fillers elsewhere (cheeks, smile lines, around the mouth), you can do multiple areas in one sitting with a fat transfer.

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Lateral lower lid hollowness after blepharoplasty

It may be possible to improve your lower eyelid hollowness by using fat grafting techniques. A skilled fat grafting surgeon should have experience in treating this area. Check out my link below to learn more about fat grafting.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Fat transfer effective in post surgery lower eyelid hollow

Lower eyelid hollowness after a blepharoplasty can be due to a couple of reasons.  The most obvious one is removal of fat beyond the optimal amount.  The other is mismatch of the eyelid fat and the cheek fat.  Most often there is a depression along the bony rim of the socket toward the out side of the lower eyelid before the operation.  This is the gap between the eyelid fat and the cheek that happens with age or by nature.  If you take out the eyelid fat to match the bony rim, the entire area from bony rim up appears hollow.  Slight excess should be left or fill the rim area with the excess fat.  Pulling the eyelid muscle up also helps in muting this depression.  At any rate, hollowness after lower eyelid operation is not an infrequent finding if these precautions are not followed.

Once happens, however, it can be corrected by injecting fat.  It can be done after 6 months from operation.  Fat should be laid along the bony rim.  Injection into shallow levels into the eyelid can be done if needed but with extreme caution.  It should be done by an experienced person.  I would not recommend this right now since you just had a lower blepharoplasty but if a midface lift is done through the lower eyelid the bony rim area can be filled resulting in a smoother transition from the cheek to the eyelid minimizing the hollow appearance.  You might reserve this for the future.

Hope this helps.

Seung K. Kim, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 9 reviews

Under eye hollowness

It sounds the hollowness happened after the lower lid surgery. So one will assume that too much fat was taken, or fat was taken where it did not need to be taken.

It can be corrected with fat transfer. However now you have a scarwhere the fat is to be injected and the results are slightly less predictable because of the scars. You may need more than one session of fat transfer. Make sure the fat is injected with a blunt cannula, and should be placed deep to the muscle. the fat transfer can be done about 3 months after complete healing.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

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