Upper/Lower Eye Surgery 6 Months After Right Under Eye Hollow Problem. More Filler or Fat Transfer? (photo)

I went back to my board certified PS with my right eye (underneath) concerns. It looks hollow and uneven. Before surgery he put in 3 radiesse syringes in cheeks. At my 6 mo check up he addressed my under eye concern with another syringe of filler (cheek area). I am still not happy with it. I got a 2nd opionion and that board certified PS said i need a fat trasfer. Can filler not fix this issue or will I need another surgery? Side note i have used latisse (4 days with redness in right eye)

Doctor Answers 7

Under eye hollows

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Something safe to use for under eye hollows is restylane injection as it is natural and reversible.  See an oculoplastic specialist.

Filling Eyelid Hollows

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Either filler or fat would help to fill the hollowness and make the rim less noticeable. Hylaform lasts about 9 months to a year and is easily injected in the office. Fat transfer would likely last longer but require the fat be removed from a donor site from you.

Upper/Lower Eye Surgery 6 Months After Right Under Eye Hollow Problem. More Filler or Fat Transfer? (photo)

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The result is good and I see the jolliness. I might consider very purified PRP enhance fat grafts, only 2 to 3 cc's per eyelid. 

Hollowness after lower blepharoplasty

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If during your lower eyelid surgery, significant amount of fat was removed then you may end up with hollowness and visibility of infraorbital rim. Use of fillers can be easy temporary fix but probably not a long term solution. Fat grafting can help restore the lower eyelid contour but there will be some variability of graft survival. Make sure you are completely healed from original surgery before going through with revision.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

More Filler or Fat Transfer?

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My first preference would be a fat transfer technique, but you may have had the fat removed at the first surgery. The second option would be fat grafting but that is a very tricky area for fat grafting so make sure you see someone who is highly experienced in the technique.

Under eye hollowing

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From the pictures, there seems to be significant volume loss under your eyes, exposing the rim of the orbit, the right worse then the left.  Sometimes asymmetry exists naturally and it just becomes more evident after surgery.  Fillers can improve this volume loss, but in the area around the eye you would want a hyaluronic acid filler, such as Restylane or Juvederm.  Hyaluronic acid fillers are only temporary and typically last around 6-9 months.  Fat transfer is a great option for you since it provides a more permanent option and in the long run would be cost effective if you are utilizing a good amount of fillers in the cheek as well.  The procedure utilizes fat from one part of your body to restore volume in your face.  

Lower eyelid surgery

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Dear meko,

  • If you are getting fillers in the cheeks and also have under eye hollows, a fat transfer would be perfect for you
  • Its effects are permanent, natural looking and you can have those hollows adressed
  • With precise fat transfer, we can sculpt the lower eyelid and cheek areas so that it looks great
  • In addition, it is easy to add fat elsewhere, like the smile lines and jaw lines for an overall rejuvenation if you are interested

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

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.