What can you do about hollows under eyes made more noticeable after fat grafting to cheeks? (photo)

I am 54 years old. Went to board certified ps for cosultation. He said I had a very thin face and fat transfer would work well to add volume. Had fat transfer to cheeks and temples. Temples ok, but fat to cheeks has made eye hollows more pronounced and seems it made loose skin at corners of eyes even more noticeable. And, it's harder for me to smile. Used to have a bigger smile. Sad I put the fat in cheeks. Anything I can do now? Had this procedure 2 years ago.

Doctor Answers 4

Post fat transfer

When you had the fat transfer it would have been a good idea to put some fat into the tear trough/lower lid as well.  This is more difficult than putting it in the cheek since the skin is so thin, but when done correctly can help with any hollowing.  At this point you should try some filler to the tear trough.  Some botulinum toxin to the crows feet would help with that area.  
For the cheeks, you could try Ulthera.  We have found that it can help to flatten areas that are overcorrected from fat and other fillers. Worth a try.    

Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

The eye hollows are best treated with fillers, lasers, microneedling/PRP and skin care unless you are looking for surgical removal of eye bags.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews

Making a proper assessment of the lower eyelids

The transition between the lower eyelids and the midface is it complicated anatomic area.

And the ideal youthful face to contour is snug along the lower eyelids with no bulging or front pads transitioning into nice full cheek volume.

Signs of aging usually include bulging of the fat that's in the lower eyelids followed by a hollowness just below this the lack of volume in the mid cheek.

There are three separate anatomic areas involved.

 The lower eyelids which may or may not have protrusion of fat pads.

The tear trough deformity or hollowness at the lower eyelid cheek interface.

Lastly is midface or cheek volume.

in your case your tear trough deformity or hollowness at the interface junction may have been made worse by adding midface volume.
One area looks the way it does in relationship to the adjacent areas.

As one area where the volume deficit has volume added next to it it appears smaller.

You need to have an in person consultation by a plastic surgeon who has great expertise, excellent sense o aesthetic judgment and I has the techniques needed to correct any of these conditions.

One option may be to have a lower eyelid blepharoplasty with very careful augmentation to the tear trough.

A lower eyelid blepharoplasty by itself may also give a nice improvement giving a more balanced appearance.

Regardless this anatomic area is difficult not only to assess but also to treat.

The transition between l potential excessive volume immediately adjacent to a lack of volume makes the area challenging for even the most talented surgeons.

Mats Hagstrom M.D.

Mats Hagstrom, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 17 reviews

What can you do about hollows under eyes made more noticeable after fat grafting to cheeks?

Hello Maydoggie,

If you had hollows to start with and then added fat to the cheek, it would make it much more noticeable.  The hollowing under the eyes is noticeable because of the valley that develops below the lower eyelid and the cheek.  If you raise up the cheek (as with fat grafting) then the valley appears deeper and the area more hollow.  Since you only posted one photo smiling that isn't a sufficient view to comment.  Frequently you can use fillers to help improve the hollowness.  For the skin at the corners of the eyes there are sometimes some topical products or skin resurfacing or even neuromodulators that can help.  

As far as options now, I would recommend an in person consultation with a facial plastic surgeon.  This way you can be evaluated and the best course of action determined.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 23 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.