How should I decide between fat transfer and fillers for under eye bags? (Photo)

Hi- I am 28 years old with hereditary undeye hollows which swell into "bags" in the morning. They seem to be less swollen by the end of the day looking more like hollows than bags. Assuming allergies, I eat healthy (no dairy, gluten, whole foods) and use an air purifier but the swelling has always been there mornings. My question is- How should I know whether fat transfer vs. filler injections is best? Is one better over the other due to age, longevity, skin type etc.? Thanks in advance!

Doctor Answers 11

Under Eye Hollowness

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Thank you for your question. I typically prefer an injectable filler for under eye hollowness such as Restylane. I feel that it is more predictable then a fat transfer. I would recommend an in person exam to determine your candidacy.

Dr. Daniel Ritacca

"Allergic shiners" are a myth.

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It was a concept developed by a pediatrician in the 1960's to placate moms asking about why their kids had under eye dark circles.  Under eye hollows are a natural feature of the human face.  The various views you are demonstrating in the photos are primarily dependent on how you are positioning the face and eyes.  Look up and the lower eyelids elongate emphasizing lower eyelid color.  Look down and activate the lower eyelid retractors which makes the skin tuck in.  I see 2 to 3 new consultations each week for the removal of grafted fat.  The reality is that micro fat or not, grafted fat scars the natural glide planes of the lower eyelid and mid face.  There is no fixing the damage done by grafted fat.  The hyaluronic acid fillers are by far much better than any surgery.  The service lasts about a year.  It does require a very experienced injector to get the most from the service.  It is a very comfortable office service.  If the treatment needs to be adjusted, this can be down at any time with the injection of enzyme.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fat vs filler

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This depends if you want a permanent result or temporary. Typically fillers are temporary where as fat is permanent. 


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This fluctuation is dramatic for your age.  A thorough evaluation to determine if this is an allergic phenomena that can be treated would be prudent.

Treating a fluctuating deformity with surgery or fillers can make things worse.  If you remove fat, you may look worse in the afternoon.  If you overfill, you may look worse in the morning.  

If no treatable condition is identified, then proceed only with temporary fillers, not fat.  Very conservative injections are started to see the effects and build up.  If it looks worse, stop the injections and you will not have permanent deformity.

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

Fillers or Fat For Lower Lids

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For many of my patients and this might apply to you, I recommend if they are unsure of what they may look like afterwards is to have fillers placed in the cheek/lower lid junction. The advantage is that you get to try out your new look. If you like it then next time around go for a more permanent fix with fat transfer.

Fillers are popular

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Office fillers are an excellent first step and can be modified if areas are too high or two low and fillers can be dissolved.

Under eye hollowing

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Thank you for the photos. Both filler and fat grafting can be used for your particular situation. The quickest and simplest solution would be to have hyaluronic acid fillers such as Restylane to your lower eyelid area to smooth and lighten the shadows from hollowing in the area. If too much filler is injected, it can be quickly dissolved with hyaluronidase. There is minimal downtime but it will last for less than a year before you need more filler injected. For permanent results, fat grafting can be performed. Fat will need to be harvested from your body resulting in a tiny scar from where the harvesting cannula is inserted. Fat grafting is more unpredictable than filler due to the larger size of the fat particles that are injected and a variable amount of fat will be absorbed before the rest becomes permanent. There is also a greater amount of downtime with fat grafting - you can expect to be bruised and swollen for a few weeks. If too much fat is injected and stays permanently, it can only be corrected with additional surgery. If you are unsure, you can try filler first before resorting to a permanent fix such as fat grafting. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!

Johnson C. Lee MD
Plastic Surgery

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

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Fillers, lasers, and microneedling/PRP can improve under eye hollows. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 202 reviews

Under Eye Hollowing

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Hi Eppy, it looks more like hollowing under the eyes than protruding fat pads.  For this we would suggest injections for someone your age.  To see examples of similar situations for other patients and their before and after photos, click on the link below.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Options for under eye bags and dark circles

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You have 3 option for your under eye bags and hollowness (dark circles).  1) Filler injection in hollow area which is safe, very predictable, and lasts 1-2 years.  2) Fat injection, which is not as predictable as filler but lasts a long time.  3) Transconjunctival lower blepharoplasty with fat repositioning.  Need to see more photos or examine in person to better tell you if candidate for #3.  See link and video below.

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.