Will fat grafting help my tear troughs? (photos)

Question

I've had restalyne and juvederm in the past but once it made my undereyes worst. Next time I received it, it was better but not perfect. I still think I have a little lump. This was done in Feb 2015. Would fat grafting be ideal for me? If so how much and the downtime?

Randal Haworth, MD, FACS · Answer

Thanks for your question and photos. One approach to correct under eye bags is to carefully inject a temporary filler (such as Belotero® or Restylane®) underneath the skin with magnification. This could be quite effective but does involve the risk of producing irregularities and lumps and will necessitate a certain amount of bruising. A permanent filler such as Bellafill ® or even a fat transfer utilizing purified fat from your body, is also a great choice. By injecting onto the upper cheek below your actual eyelid will help hide your lower eye bags.

Robert M. Lowen, MD · Answer

Depending on your age and how much you really need filling, fat can be a good alternative to fillers. It is permanent, but only a percentage 60-80%, may take, so it may need to be repeated.Since you are relatively young, you should discuss with your plastic surgeon what are your main concerns. People in their 50's and 60's need more fat and over a wider area than those in their 40's and occasionally late 30's with tendency to show hollowing or atrophy earlier. For patients in their 40's and older who have been getting fillers and like the effect, we do discuss fat grafting as an alternative. The recovery is not too bad, with some swelling for a week or so, and sometimes bruising. The procedure is done with very thin cannulas, and at a deep enough level to avoid surface visibility or lumpiness as much as possible.

Jason Emer, MD · Answer

Fat grafting is an option, but can be unpredictable in this area. I like a combination approach with fillers, lasers and microneedling/prp. See an expert for a formal evaluation. Best, Dr. Emer

Nima Shemirani, MD · Answer

Dear kalypso7,You can do fat transfer under the eyes for this issueI think it is better to get fillers if it is only this area because of the down time associated with fat transferYou should see an experienced injector, the use of a cannula will help tooit is best to have an in person examination so we can go over your anatomy and see what would work best for youBest,Dr. Nima

Toby Mayer, MD · Answer

This location is not good for fat as it often forms a "sausage" and needs surgery to remove it! Volume carefully placed is a better option and can be reversed if need which is rare if you see a very experienced injector.

Walton Montegut, MD · Answer

This is a good question.  Fillers work very well in the tear troughs.  Some are better than others, so the choice is individualized to the patient.  Juviderm causes the most amount of swelling so there are others which are better.  I use fat transfer the same way filler can be used on the face.  On all my facelifts, I fill the tear trough with fat in a very delicate way.  I do it much the same way filler goes in, however, fat is long term and the results are amazing.  The surgeon must be familiar with this area.  It is fraught with complications if not done correctly.  So, choose your doctor wisely.  There are benefits to using fat over filler.  Therefore, you can use either.  Good luck.  I always say, your face is the diamond, polish it brilliantly.

Tracy Leong, MD · Answer

Thank you for your question and photos. Fat grafting would help fill this area and allow you to look more well rested. With fat grafting most patients will experience downtime of around 5 days to 2 weeks, depending on how fast you heal. Although I frequently use Restylane under the eyes, I avoid Juvederm because it tends to collect water and make the tear troughs appear puffy. This may have been what caused you to have a bad experience previously. As with any cosmetic procedure, it is important to make sure you consult with a board-certified plastic surgeon or dermatologist to help determine what procedure is best for you! I hope this answer is helpful. Best of luck!

Jon A. Perlman, MD (retired) · Answer

Fat grafts run the risk of turning into a fibrous "ball" similar to chewing gum that needs surgical removal if placed or migrated to a position under the thin lower lid skin.  Hyaluronic fillers are generally the most reliable treatment if properly done IMO.  Regards,
Jon A Perlman MD FACS 
  
Certified, American Board of Plastic Surgery 
  
Extreme Makeover Surgeon ABC TV 
  
Best of Los Angeles Award 2015, 2016 
  
Beverly Hills, Ca

Harrison C. Putman III, MD (retired) · Answer

My experience with fat transfer in this area is very positive, especially when more volume is needed to "frame" the eye. However it is less predictable than fillers for tear troughs only. I prefer Belotero, which is a monophasic HA filler for this area, and it works beautifully.

Val Lambros, MD, FACS (retired) · Answer

I've done far for 25 years, though one can see nice results, the fat will grow if you gain weight. If you don't like the results it can be very difficult to remove the fat. I prefer well done ha fillrrs, which will last up to 4 years.

Will fat grafting help my tear troughs? (photos)

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