How Long Before Final Results from Fat Transfer in Tear Trough Can Be Seen?

More than any other procedure I have done, fat injections do not consistently provide the same results even in the same patient when performed mulitple times within a series of treatments. Fat injections are often done as multiple treatments. Some results are better in the first treatment while other patients have results better in subsequent treatments; it is hard to determine the percent of viable fat after one procedure. If the fat is injected over the muscle, it might be more noticable as bumps when the injections "take". some fat doesn't live in the new environment. It may take three to six months or even a year or more for the fat to stabilize. Injecting under the muscle may provide a smoother result, but the hosting environment may not allow the fat to live as well as the plane above the muscle. If there is overcorrection that does not decrease with time, the fat may be injected with a low concentration of corticosteroid, but there is a risk of cataract development and over thinning of the fat or a depression of the skin which might need filler to raise it up again.

It is important to have this area done by someone who has experience. Fat transfer to the tear trough can be tricky. Overcorrection is performed by most plastic surgeons in order to avoid a second correction of the area. This overcorrection together with local swelling can take up to 6 months to resolve while some of the dead fat is being absorbed.

Generally, at 3 weeks following the procedure, you should have an impression of the final result. However, it will take somewhere around 6 months to truly know the permanent effects of the surgery as it does with any facial surgery.

Hi Danny,
The tear trough is a very delicate and tricky area to treat with fat transfer. Approximately 40 to 60% of transfered fat will live after transplantation. It takes about 5 to 6 months for the fat to settle, for the fat cells that are not going to make it to be reabsorbed. After 5 to 6 months, what is left is live fat cells, they should be there for life. It is much easier to add more fat in this area than to have to remove extra fat, so it is better to be conservative. Good luck and be well.
Dr. P

My approach to fat grafting is not to over-correct. It is dificult to know how much fat will persist. The objective is for the fat to build a blood supply and be permamant. Overcorrecting can provide an extended recovery period at best, and a permanently distorted appearance for many. In some cases, a follow up fat grafting procedure could be desired.  An unavoidable reality of fat grafting is that the degree of fat survival cannot be completely predicted nor can it be guaranteed. Fat survival will vary somewhat from patient to patient and from procedure to procedure. My impression is that many surgeons ‘manage’ this issue by overdoing it when they perform fat grafting surgeries, assuming that a significant amount of the grafted fat will not survive. This leaves patients vulnerable to an unnatural, over-grafted appearance if fat survival is greater than the surgeon expects.Excessively full cheek volume is currently seen quite a bit in the media, and it is probably a consequence, at least in part, of the widespread popularity of temporary soft-tissue fillers such as Juvederm and Restylane. Full cheeks are fine, to a point, but if overdone it can produce an extremely odd and unnatural appearance. It appears particularly unnatural on animation, as when the cheek volume increases with a full smile. Look carefully for excessively full cheeks in your surgeon’s ‘before and after’ photos, as the fullness you’ll get from fat grafting surgery is not temporary.My approach is to graft fat to the point that the soft tissue contour is, in my opinion, aesthetically ideal but still quite natural-appearing. This eliminates any concern of an ‘over-grafted’ and unnatural appearance. In my practice we offer secondary fat grafting for areas that I have previously treated at a significantly discounted cost from the initial procedure. That allows patients to go into their surgery with confidence that (1) they will not have unnatural appearance after recovery from surgery and (2) any areas that require additional volume enhancement can be treated at a very reasonable cost. Areas which have thinner soft tissue thickness preoperatively - such as the lower-lid cheek junction - are the areas that are most likely to require secondary (and occasionally tertiary) fat grafting procedures.