Why can't you do fat transfer on the upper eye but you can do filler?

Question

Looking at upper eye filler work...it's the only example I can find of filler being done to the top of the eye/eyelid. More specifically to fix the aging look of hollowed eyes and that slant of fat loss on the inner upper eyes that look like this \ / when looking at the eyes. How is filler a tool for this issue, but only a handful of people are doing it, and none that I've found do fat grafting instead? Or is this just advanced and I can't find who does fat instead?

Ayse Dolar Bilge, MD · Answer

For upper eyelid hollowness, we prefer fillers initially because if we can't achieve perfect symmetry, adding more filler is easier. With fat injections, achieving symmetry involves technical challenges like removing and reinjecting fat, and fat can sometimes increase in volume over time. Therefore, our primary choice is fillers, but fat can also be conservatively injected along with other facial areas.

Ajaya Kashyap, MD · Answer

Thank you for your query. It is common to do both fat and fillers for lower eyelids but less so for upper eyelids. However , I do fat transfer for upper eyelids occasionally, as do many others.  The important thing is to refine the fat much more as a bulge in the upper eyelid can look very unsightly, and injection has to be done very carefully because of risks of embolism close to the eye, which is true for lower eyelids as well.  So, a lot of experience is needed. Please find an experienced Board certified Plastic surgeon who can examine you and help you. All the best!

Zoran Potparic, MD · Answer

Placing a fat grafts, nano or micro, to correct contour of upper eyelid has been done for many years in our practice. You should search board certified plastic surgeons in your area for an answer. Good luck.

Daniel P. Markmann, MD · Answer

Upper lid fat grafting is definitely an option.   I would definitely recommend fat over filler.  Either one can be used.  Filler always goes away.   When you use fat, whatever fat cells survive will be there forever.   You may need to do fat grafting more than once to get the results you are seeking.   but it is definitely better than the every 6 months filler!

Mark T. Boschert, MD · Answer

Yes, fat grafting, or filler can be done in the periocular area, including the upper eyelids, and that pesky little hollow you were describing near the medial aspect. It is something I use quite often in facial rejuvenation. You are also correct that it is a very advanced technique. There are a lot of little blood vessels in that area and calculating them can lead to blindness. That risk is talked a lot about among filler gurus, and should be respected. With that said those of us who have decades of experience will use all of these techniques judiciously with or without other surgical intervention.
Best of luck! Dr. Mark Boschert Renaissance Plastic Surgery, St. Louis, Missouri

Why can't you do fat transfer on the upper eye but you can do filler?

Answers (5)