(23F) How to fix hollowing of under eyes? (Photo)

Question

I have had two fat transfers to mid cheek/under eye area. The fat does not seem to be taking well under the eye, what are my other options besides filler?

Gary M. Horndeski, MD · Answer

A lower blepharoplasty can be done to transpose from your orbital region and into the tear troughs to increase fullness.

Best Wishes,

Gary Horndeski, M.D.

Philip S. Schoenfeld, MD, FACS · Answer

I am very curious as to the ineffectiveness of fat grafting to the lower eyelids.  Not taking is not generally the complaint that I here from patients.  Over filled or lumpiness is far more common than poor fat graft survival.  I might consider seeing another provider with more experience in micro fat grafting of the lower eyelids.

Zoran Potparic, MD · Answer

Considering that small cheek bones are the major cause of your condition, augmentation with cheek implants should be considered as well as lower blepharoplasty. Good luck.

Dana Goldberg, MD · Answer

At this point, your options are PRP or PRF. Some surgeons do tear trough implants, but that’s more risky.

Mats Hagstrom, MD (license on probation) · Answer

Fat transfer is in precise and unpredictable in the face.
The survival of the grafted fat is highly dependent on the amount of tissue the fat is grafted into.
In that sense the area that needs volume the most is going to have the lowest percentage of fat survival.Facial fat transfer may seem like the ideal option, but grafting fat should never be considered an alternative to the use of fillers, which is the gold standard for this kind of work.
The ability to do quality work with facial volume enhancement various substantially among providers.
Consider looking at the results by Dr. David Mabrie MD in San Francisco.
He has an impressive number of before and after pictures on his website.
Real self does not allow me to include website links so you’ll have to look up his website on your own.
David is a facial plastic surgeon who is practice is devoted exclusively to facial volume restoration using fillers.
 his work is by far the best I’ve ever seen and I consider his work the standard.
I’m not suggesting everybody fly to San Francisco to get facial fillers, but seeing his results can serve as a powerful educational tool for patience to understand what can be achieved using only fillers.
Once you know what can be achieved in the hands of the right provider you can use that information to guide you towards finding the right provider in your community.
I have a lot of respect for those who do this kind of work well on a regular basis.
It’s not easy or straightforward.
I personally have given up on facial fat grafting because the procedure is inherently unpredictable, imprecise, and potentially unforgiving if patients don’t like the outcome.
For sure provider selection is critical if someone is going to move forward with facial fat transfer.
I personally think fillers is a better way to go.
Best,
Mats Hagstrom MD

(23F) How to fix hollowing of under eyes? (Photo)

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