Why a Fat Transfer for Eyes?

Fat transfer in general, and fat transfer under the eye in particular, seem so unpredictable and yield so few satisfactory results;so why do it when other less expensive and more reliable alternatives are present? I would like to know the best solution and/or remedy for under-eye hollows and dark circles. Thanks...

Doctor Answers 6

Composite Fat Grafting Not Fat Transfer or Fillers Best For Hollow Eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question. I use a composite fat graft a whole piece of fat harvested from the pubic area and transplanted into the eye. These grafts survive better than injected fat called Fat Transfer and results are more predictable.

My reasons for not using fillers are:

  1. Fillers often move as the eyelid muscle pushes the filler out of the depression and causes a worsening of the shadow
  2. Fillers are often placed incorrectly
  3. If placed to superficial filers can cause visible grey lumps on the eyelid skin
  4. I don't like injecting through a needle into the eyelid-there are many delicate structures that can be inured by a physician untrained in eyelid surgery
  5. Blindness has been reported in England following filler injections into the eyelid
  6. Fillers are temporary-repeated injections are necessary

The most important thing is to find a skilled experienced eyelid surgeon and follow his/her advice. I am sure there are excellent surgeons who can achieve good results with any of these techniques-the key is to find the right surgeon.

Why use fat grafting for the lower eyelid area...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Actually, fat grafting under the eyes, if performed properly is very predictable and successful.  Fat grafting is also the most natural way to build up volume for the hollow area under the eyes.  The fat injection should be repeated one or two times during the year to build up a long lasting effect, and since it is your own fat, there will never be any reaction to it.  It can also be used in other areas such as the nasal labial folds, lips and hands.  Some of the fillers such as Juvederm can be unpredictable and can cause long term swelling under the eyes, necessitating additional treatment to correct it.  Fat grafting is a simple procedure, and when done by a board certified facial plastic or plastic sureon has wonderful results.

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 reviews

Achieve a more natural look with a fat transfer.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As we age we lose volume, the most common area of volume loss is under the eyes. Compared to more traditional procedures such as a lower blepharoplasty (removal of under eye bags) a fat transfer is much more natural and subtle. A common complaint with lower blepharoplasty results is patients can still have a “tired look” whereas with a fat transfer there is a fuller more youthful look. Also, the recovery time with a fat transfer is much less and patients experience less pain since there are no incisions made on the face, the only incision made is at the harvest area. Results can vary from patient to patient, but the average fat transfer can last up to 12 years. With this being said a fat transfer compared to dermal fillers is much more cost effective.

I suggest speaking with a Board Certified surgeon to go over your options that are tailored to your specific needs and goals. This is the best way to feel confident in the path you choose.


Philip Young, MD
Bellevue Facial Plastic Surgeon

Fat is the Ultimate Filler

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Many plastic surgeons consider rhinoplasty the most demanding facial surgical procedure.  I believe that using fat transfer techniques, especially around the orbital area, is the most technically difficult, but also the most rewarding if done well and safely.  Because the transfer of body fat can reshape the aging face back to its natural youthful fullness, I think it is truly the only technique that can convincingly restore the brow, cheek and eyelid youthfulness. The other benefits is that volume for volume is is the cheapest filler, it's permanent, it can and should be done in stages (not overcorrected), and there is mounting evidence that there is a physiological benefit to the facial skin when the fat compartments in the face are restored.  It is an office procedure that can be done under light or deep sedation, depending on the patients comfort with the injections, and can be combined with blepharoplasties, brow and facelifts.

Jeffrey Ptak, MD, FACS
Phoenix Plastic Surgeon
4.7 out of 5 stars 8 reviews

Fat Transfer to the Face

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Fat can often be helpful to retore volume to the face in places where it has deflated, or to make subtle changes to the face.  Eyelid skin is thin, so fat transfer there can be tricky.  Fillers such as juvederm or restylane are simple and they disappear if the result is not an effect you like. Fat injections are actually a surgical procedure, not just an injection. For permanent correction of lower lids I prefer a surgical approach that releases the tear trough deformity and repositions fat that is present in the orbit to fill in the crease of the eyelid skin near the nose.  This is far more reliable than fat transfer in that location. 

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Fat Transfer is a Permanent Filler

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Every artisan has their selection of tools for a particular purpose, and as a Plastic Surgeon, we use different fillers for different purposes.  Fat is a useful filler for correcting the under-eye hollows (tear trough deformities) in a permanent fashion.  Not everyone is comfortable or formally trained in performing facial fat grafting and even fewer are comfortable in performing this procedure around the eyes.  Therefore, there will always be a certain negative commentary regarding tear trough correction with fat grafting from "cosmetic practitioners" that are not formally trained in this procedure.  Plastic Surgeons that routinely perform this procedure should be able to show you before and after pictures that demonstrate the efficacy and safety of periorbital fat grafting.  This may not be the best solution for your particular problem, but it is a good solution for some patients.  Best wishes in achieving your goals. 

Luis Zapiach, MD
Paramus Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.