Fat transfer to the periorbital area, should I try it again?

Facial fat transfer, especially when compared to fillers, is unpredictable, and precise, and can be unforgiving if patients don’t like the outcome. Fat survival is based on a multitude of factors. Of these the most important is the presence of post tissue to support the grafted fat. The periocular area has very thin layers of subcutaneous tissue to graft that into. In other words, there is a shortage of host tissue, and this causes fat graft to have poor, take and often unpredictable Survival rates.
I generally steer people away from fat transfer to the face, especially around the eyes, because of the number of patients who have complications all right I’m happy with the outcome, and the difficulty in dealing with trying to remove previously graft fat in the face.
They are young could be augmented, alternatively, using implants or a mid-facelift(very different from a traditional facelift)
Best,
Mats Hagstrom, MD