I have a question about fat injection on tear troughs - which is best?

Question

For injection on drop tears which on is better? Fat or filler(hyaloronic acid) ? Dose fat injecting safe ? And can doctor inject it in very small and sensitive aera like drop tears?would be very exact injection?

Stephen T. Greenberg, MD, FACS · Answer

Hi there and thanks for your question.  Fat and HA fillers are both great for under the eye (tear trough area).  Fillers only last about 8-12 months depending on what filler you use.  Fat is permanent but only about 50-60% of the fat injected to the area is retained while the other 40-50% will absorb.  The fat can be taken from any part of the body and is purified before being injected into the face.  I recommend an in-person consultation with an experienced plastic surgeon. Best of luck!

Rohit Jaiswal, MD · Answer

Thanks for your question. 
Either fat or filler may be used to inject in the tear trough areas to improve hollowness. Each one has advantages and disadvantages. 
First, it is necessary to determine that volume is needed in the lower lid/tear trough areas. The patient needs the right anatomy- hollowness without significant skin excess and without herniating fat in the area. Usually the patients are younger. 
Once it has been determined that volume is needed and nothing else, then deciding on fat vs fillers is necessary. Fat has the advantage of being permanent and natural, and the stem cells in fat are thought to help with the dark pigment in some patients. It has the disadvantages of requiring a surgical procedure, is more expensive, and the success can be variable. Patients will sometimes need multiple rounds of fat grafting to get the desired result. 
Filler, on the other hand, is easy to inject, can be done in the office in a few minutes, has little downtime, and is relatively inexpensive. However it is not permanent, and there is risk of contour irregularities that may not smooth out over time. 
There is no greater increase in risk by injecting fat compared to filler, in my opinion. The main safety point is to be sure the injections are done with low pressure and in the correct plane in order to avoid the complication of an embolus which can cause blindness. This can happen with either fat or fillers. Fortunately this is very rare but does illustrate why it is important to get this done by a physician who understands the anatomy and injection technique. 
Best wishes, 
Rohit Jaiswal, MD
Plastic Surgeon, Las Vegas, NV

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Fat grafting and fillers can be used to fill the tear trough area.  Fat grafting is a permanent method to add volume, while fillers may dissolve over 9-12 months, depending on the type of filler.  Both can have a nice result when good technique is used.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. Fat can also be used to rejuvenate the area. Fat transfer technique is important for successful transfer. I recommend water-assisted harvesting with prp for best outcomes. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Jeff Rapaport, MD · Answer

The  key to treating under eye tear troughs is to find an experienced practitioner. Fat, filler or PRP are acceptable treatments. The Advantage of using PRP is that it also improves the skin, quality, tone and wrinkles.

Karthik Ram, MRCS, DNB · Answer

Hi thanks for sharing your question. Both fat as well as fillers can be used to correct tear troughs. Fat fill gives volume which is permanent and the stem cells in it helps to improve the pigmentation if any. But about 20-30% of fat which is injected may get absorbed and  more than one sitting maybe required to achieve the desired results. Hope this will help you.

Mark T. Boschert, MD · Answer

The delicate area of which you speak around the eyelids can be filled with very good fillers or fat. Yes there are tools and expertise to lay down the fat very nicely and give a very long-term result. You should search for a plastic surgeon in your area with the significant experience with fat grafting and facial aesthetics. Then let the artist do their work:) Best of luck, Dr. Boschert

Robert Brueck, MD · Answer

Yes it is safe but again the skill of the surgeon is imporatnt.Fat will last longer and I would consider nano fat grafting.

Richard Zinn, MBChB, MMED, FRACS · Answer

You ask a very interesting and controversial question:
Tear troughs can be addressed with injection of fat or filler.  The area is sensitive as there are blood vessels in this area that are at risk of having the fat and or filler injected into them.  The implications can be quite serious.  Experienced injectors will know how to prevent these issues.  Also, because the skin is so thin, much smaller quantities should be used to avoid the filler being visible to the observer.
When you ask which is better - a number of factors should be taken into account:
Filler is cheaper and quicker but will only last 12 -18 months.  This could be a good thing if you decide you don't like the result.  Fat is permanent and may not need to be repeated if performed well.  It should be performed under sterile conditions in a clinic or theatre and is more expensive. It will also need the fat to be harvested from another site - which means a second surgical site.
My preference is fat injection, but I don't mind using filler.

I have a question about fat injection on tear troughs - which is best?

Answers (9)

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