Fat Transfer for Under Eye Hollows

The lower eyelid skin is very delicate. It is also very thin. Any irregularity shows through. One of our most common reason for performing revision lower eyelid surgery is palpable and visible lumpiness from prior fat injections. Many of the revisions are minor. Often, however, there are uncorrectable problems from gristly fat located in many planes of tissue. The reason for this is in the biology. Fat injections cells are harvested by liposuction. the fat cells are then usually spun in a centrifuge and then injected back in. During this process, most cells die. The number is debatable, depending on whether the viability is judged by microscopic examination of the cells (ie trypan blue exclusion method), or by metabolic methods, measuring the cellular machinery. However, the number of live cells is in my opinion between 3% and 25%. The rest are dead. As the dead cells are eaten away, an inflammatory reaction develops characterized by macrophages (large white blood cells), chronic inflammation and coalescence of fatty cysts, or dead liquid fat. We have presented and published our results on the histology of fat injection specimens. We have found the belief that volume existing at 6 months after fat injection technique consists of live cells to be false. Rather, the bulk that remains consists of all the cellular elements above, still very actively eating away and walling off the dead cells and fatty cysts. The bottom line is that intense cellular changes continue to occur with fat injection, usually characterized by further loss of fullness, even at 1 1/2 years after injection. This does not mean that there are not many happy patients out there with fat injections to the lower eyelids. There are especially when the technique is conservatievly performed in highly skilled hands. Just be cautious before injecting fat into the lower eyelids.

Hello, this procedure can be performed under local anesthesia in the office similar to a filler experience. Your surgeon should be conservative under the eyes (especially compared to other parts of the face) but the fat that survives will be permanent.

Thank you for the question.  I have noticed from seeing many patients who have had fat transfer that there is a very high dissatisfaction rate for the procedure.  Most of the time the fat gets resorbed, or even worse it becomes lumpy.  I have noticed this even in the hands of experienced surgeons.  It is very much a hit or miss procedure so I advise against it.

Hi, thank you for this question, and this is one of the most consistently asked questions in our practice. Unlike fillers, fat is a living cell-adipocytes.  When we remove fat from one part of the body, we are cutting off the circulation to these cells and they will die unless they receive new blood supply.  When we place these fat to a new place, we are expecting new source of blood supply to grow.  Once they do, the fat cells will survive and they will last for a very long time.  So it is crucial that the techniques used to harvest fat, purification, and placement of fat in the new location all increase the possibility of fat survival.  When these techniques are used, fat grafting is very consistent a wonderful method to volumize with a natural and long lasting result. 

Fat grafting to the area of the lower eyelids does work if done correctly. It can also be permanent. Caution must be exercised to avoid over filling, and to avoid serious complications such as loss of vision.

This is a very effective treatment when properly performed.  The results are very long lasting although the face will, naturally, continue to age over time.  I have been performing fat grafts to the under eye area for 25 years and have seen many outstanding and long-lasting results.  Make sure you seek out a board certified plastic surgeon with a lot of experience performing this procedure. 

Dear nabila,There are a lot of conflicting views regarding this procedureI find that fat transfer under the eyes work well, especially in surgeons who have a lot of experience in thisThere are special techniques to reduce the chances of nodules, and if you go to someone who is very comfortable with injections, you should have a great resultBlindness does not really happen around the eyes (mostly the nose and glabella - the space between the eyebrows)Alternatively, fillers under the eyes look fantasticIf you are pretty young (less than 25-30 years old), I would be cautious about fat transfer, and would recommend fillers.  The fat can swell up over time where you look too full as you get olderBest regards,Dr. Nima

Fat transfer is a wonderful way to naturally and beautifully restore lost facial volume. Although there are numerous options to revolumize, fat transfer has some major advantages: it is the longest lasting option to restore volume in the face, functioning essentially as native facial fat once it is transferred; it is your own fat being used, thus is 100% biocompatible; there is an abundant amount available on almost everybody, so there are no limitations to getting the volume you need and achieving full correction; fat is one of our best sources for stem cells, called adipocyte derived stem cells, which yield additional benefits due to the growth factors contained and their effects collateral tissue growth that extends well beyond just the zone of transferred fat, helping contribute to a global improvement in the facial aesthetic.
An extensive amount of planning goes into the fat transfer process, with a comprehensive look at the balance and proportion of the face being blended with the aging changes and anatomy of each individual patient.
The procedure itself is performed utilizing local anesthesia with or without sedation. Fat can be acquired from numerous sites, but choosing a site is usually best planned to help contour the body in the process, thus the abdomen, thighs, and waist are commonly utilized. 
After the fat is acquired, it is processed and prepared into micro- and/or nanofat, which have different properties and are chosen based on the desired areas to be treated. Transfer is then performed with blunt tipped cannulas, as opposed to needles. Different providers will likely have different processing protocols, but I prefer to maximize the stem cell content of my fat, further magnifying it’s benefit. This is a time-consuming and intricate process, thus some people take shortcuts, but the long-term benefits are well worth the extra effort in the preparation process. I also utilize other regenerative medicine modalities, such as platelet rich plasma, to improve the outcome from the fat transfer and expedite the recovery time.
Recovery from fat transfer includes swelling and some firmness that is subtle and can last several weeks to months after the procedure. The transferred fat establishes a blood supply in its new location, a very favorable process which contributes to that inflammation and swelling. 
It is key that the physician performing the fat transfer is well-versed in panfacial volumization, allowing an equal balance and harmony to be created and maintained in the face. Fat should not just be utilized in large volumes in a few spots, but instead utilized in strategic volumes over multiple areas of the aging face.
Overall, fat transfer provides an incredible option to restore volume that is very natural, long lasting and has the added benefit of a healthy dose of stem cells to rejuvenate aging tissues. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

You have heard correctly, and the official terminology is called fat grafting to the lower lids.   Dark circles can improve and hollowness can smooth out significantly for a very long term result.  I have had many patients now come back to see me 7 years out with significant fat graft stability.  It is a relatively safe procedure, but I recommend seeing a board certified plastic surgeon with expertise in fat grafting around the eyelids.  Good luck!

Fat is an amazing material and can add some amazing benefits to the body.  I recommend that you see a board certified plastic surgeon - so you can discuss your specific face and beauty goals. Everyone is unique and a consultation with a board certified surgeon will be the best way to answer your beauty questions. 

There are patients that do very well with fillers such as hyaluronic acids such as Restylane injected in the tear trough of the lower eyelid crease but it does not last as long as a fat transfer that "takes" in the same area.  Fat is removed from some part of your body right underneath the skin such as in the lower abdomen or  buttock with local anesthetic, treated to remove the anesthetic and injected into the new location as a graft. The cells may or may not live in the new area as they acquire new blood flow. As the lower eyelid area is a blood vessel-rich area usually the fat takes to its new home quite well. It should be done by an expert, board-certified physician who understands the anatomy of this region, and at which plane to inject the fat.
There are risks with any procedure, including fat injections so discuss this with your physician in depth.
Some patients don't have the right positioning of muscle over the bony rim of the eye socket and this can indicate the patient is not a good candidate for fat transfer. Bruising and swelling are side effects and rare risks include serious infections and even blindness.
The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs