I had lower bleph surgery plus fat transfer 2 months ago. Is it normal to still have lumps or bags under eyes?

Question

2 months ago I got transconjunctival lower blepharoplasty with a fat transfer to prevent the hollow eye look. At two months I have a horizontal lump under each eye that I imagine are the fat injections. It looks as though the doctor removed the bags except for the last tiny bit. Needless to say I'm disappointed and hoping these remaining lump/bags will disappear eventually. Will they dissipate or would you say I am at my "final look" now?

Brent Moelleken, MD · Answer

I would agree with my colleague 100%.  I do not like fat injection to the lower eyelids.  While many patients do get very nice results, others have difficult or impossible to correct problems... and both of us have special interest in the lower eyelids and mid face.The lower eyelid skin is incredibly delicate and prone to complications.  Everything shows that lies beneath the lower eyelid!That being said, you are very early in your healing and hopefully the grafts will dissipate and become much less visible with time.  Be extremely careful with steroid injections as these can cause the very delicate tissues to dissolve while not having that much of an effect on the gristle-like fat injection grafts.If you need a revision, you need to select somebody who is comfortable and experienced in the mid face.It wouldn't hurt to establish a relationship with such a person early so they can monitor your progress.

James R. Gordon, MD, FACS, FAAO · Answer

It is common practice to move the fat from the bag to the tear trough as a way of getting rid of the puffiness and filling the hollow at the same time. Harvesting fat from another location and placing it in the lowers eyelids while at the same time performing a blepharoplasty seems unnecessary. Fortunately, if the end result is not satisfactory it can be revised. Give it a few more months to heal.

Kenneth D. Steinsapir, MD · Answer

Fat is very hard to control under the best of circumstances.  In the thin lower eyelid it is even more difficult.  Placing grafted fat at the same time as removing orbital fat-does this even make sense?  I don't think so.  Surgeons go to fancy meetings where "famous" make these tricky techniques look simple and routine.  They go home and try out the technique.  Unfortunately fades come and go.  You have to live with the results.  You are only two months out from your procedure.  Generally there is still significant swelling associated with the fat grafting.  It will be another 2 or 3 months before this swelling improves to the point where it is possible to distinguish what is grafted fat and what is residual fat.  Generally I advise great caution when it is suggested that steroids be used to remove the lumps of fat.  Although it is challenging, I prefer addressing the lumps with direct surgery.

John J. Martin, Jr., MD · Answer

If you had a fat transfer, it is possible that this is a roll of fat.  We try to place the fat in a deep plane and with a small canula so that you don't get a "roll" of fat that is visible.  But it can still occur.  At 2 months you may still have a little swelling, but this may not improve. I will sometimes inject these with some steroid to soften the fat.   See your surgeon

I had lower bleph surgery plus fat transfer 2 months ago. Is it normal to still have lumps or bags under eyes?

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