Fat Transfer in Temples for Lifting Upper Eyelids?

Question

My main issues are tear trough hollowness, moderate upper eyelid hooding, moderate jowling, and lower cheek hollowness (I have very high cheekbones). I have lost a lot of volume in my temples and at the same time have developed some upper eyelid hooding. I got to thinking that increasing volume in temple area through fat transfer might actually work somewhat as a lateral browlift, thereby raising upper eyelids a little. What do the doctors here think about this theory? Could this concept also work on the jowls, with fat transfer to the cheeks for raising the jowls a little?

Ron Shelton, MD · Answer

Volume replacement / augmentation has become a significant component in the minimally-invasive technique of facial rejuvenation. Temple augmentation, whether with your own fat or a filler such as Radiesse, or hyaluronic acid, such as Perlane or Juvederm Ultra Plus can make one look younger. 
It does not create much of a lift to the outer eyebrow, but direct injection underneath the outer eyebrow does produce a slight lift of the upper eyelid, which can improve the hooding. The amount of improvement varies from patient to patient. 
Mid cheek fat augmentation, or filling with other products, such as Radiesse, or collagen stimulation with Sculptra, can help improve the smile folds by supporting the mid cheek. 
Once the cheek is better supported, there is a decrease in its tendency to fall onto the smile fold, thereby making the fold appear less deep. It does help lift the jowl to a slight extent, but the thicker-skinned jowls that have more fat lift less than the thin-skinned jowls that have minimal subcutaneous fat. 
Filler can be used, though, between the jowl and the chin (the prejowl sulcus) to make the jawline more straight.

Lawrence Kass, MD · Answer

IMHO, this simply will not work. fat transfer to the temples is an exceeding good way to treat the hollowness in the temples that occur in some individuals with age. It seems like an exceedingly ineffective way to perform lateral browlift to treat upper lid redundancy.

Larry S. Nichter, MD, MS, FACS · Answer

Fat transfer to the temples are a great way to correct atrophy induced depression that contributes to an aged appearance. The upper eyelid hooding and lateral ptosis (drooping) is not related to the temple atrophy and are separate components of the aging process. In my opinion, increasing the volume of the temple area through fat transfer will not raise the lateral brow nor will it effect the upper eyelids.

Sam Naficy, MD, FACS · Answer

Fat injections in the temples and lateral brow area can give a degree of lifting which may be enough for younger patients. For patients with a more significant amount of brow droop surgery (brow lift) is a better option.

Otto Joseph Placik, MD · Answer

It sounds that you will achieve a better and more definitive result with a lift procedure Temporal and short scar face lift.
However, the use of fat grafting may provide some correction in the gaunt appearance. It will not likely achieve a significant lifting effect.
Fat injections immediately below the outer portion of the brow can accomplish a slight lifted appearance.

Michael A. Persky, MD · Answer

Hi M&M,
It depends on your age, facial structure, and skin laxity.  Fat transfer can successfully address all of your concerns by replacing the lost volume in your face.  I have performed many full face fat transfers by adding fat to the temple area and lateral eye brow to raise and lengthen the brow.  Fat is also very carefully placed in the eye hollows, cheeks, nasolabial folds, lips, marionette lines, chin, and pre-jowl sulcus.
When performed properly the end results are quite remarkable and most natural looking.  In some patients it may be of benefit to combine the fat transfer with a mini-lift to correct laxity of the neck.
Good luck and happy holidays.
Dr. P

Brent Moelleken, MD · Answer

Fat transfer to the temporal hollowing will likely reduce the appearance of hollowness.  It will unfortunately not affect the lateral brow region, the jowl or cheek areas.
The lateral brow region responds best to a lateral browlift.  Recently, we have been doing many lateral browlifts in the widow's peak region; this preserves the deep branch of the supraorbital nerve and does not raise the hairline the way endoscopic lifts or coronal lifts can.
For the jowl region, nothing works as well as a facelift and necklift for cleaning up the jawline.
Modern facelifts also adjust volume and replace lost soft tissue volume, a way to soften the malar eminences in patients with underlying great bony structure but hollowness.  The good bone structure underneath is actually a great benefit when the facelift procedure is done.
In my experience, fat injection alone does not compensate for the sagging that has occurred, and can yield a puffy appearance.  Usually a combination of lifting and volume replacement works most effectively at restoring youth and softness.

Peyman Solieman, MD · Answer

Without examining you in person, it is difficult to determine what you need. In general, hollowness under the eyes and in the lower cheekbones can benefit from a facial fat transfer. However, a fat transfer alone cannot lift your eyelids. Depending on the severity of your eyelid hooding, you may benefit from an eyelid lift and facial fat transfer.

Daniel Shapiro, MD · Answer

Fat grafting to the lateral brow area can effectively mildly to moderately elevate the lateral eyebrows and help diminish lateral upper eyelid hooding.  The fat grafting to the temples that you ask about is really to treat the hollowing in the temples that often accompanies advancing age or weight loss.  A secondary effect can be to give volume lateral brow area, but the distance from the temples to the lateral brow make its affect secondary.

Fat transfer beautifully adds volume to the cheeks imparting a more youthful shape to the face, as many patients when given the choice of putting on weight or exhibiting a bit of gauntness in the face, pick the desirable figure almost every time.  A nice way to see how volume across your lateral brow will affect your forehead and lateral upper eyelids is to have your doctor inject some saline into the area.  You will see a temporary effect that simulates the volume of fat transfer.  I think you will like it.

Good luck.

Pat Pazmino, MD, FACS · Answer

It is possible to perform a fat transfer to orbital region for periorbital rejuvenation. Keep in mind that in this area just a little goes a very long way. This area is very sensitive and a small volume of fat added to this area can create a wonderful effect or a significant problem. For this reason, it is essential that you work with a board-certified plastic surgeon was a great deal of experience with fat transfer, blepharoplasty, and facelift. The specialist will_have a deep understanding of your facial tissues and how to create the most natural result. This surgery requires a transfer fat in tiny droplets along the borders of your orbit and into tear trough region.

Fat Transfer in Temples for Lifting Upper Eyelids?

Answers (15)

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