Would I benefit from fat grafts to the lower eye after fat repositioning failed? (photos)

In my experience fat repositioning is less predictable and involves more risk of eyelid malposition than arcus marginalis release as part of
blepharoplasty combined with fat grafting. I have performed fat grafting to the lower eyelids in over a thousand patients with gratifying results. The fat has to regain a blood supply to be successful and long lasting, which limits how
much can be grafted in one treatment. In a situation like yours when there is significant fat deficit it Woukd take more than one procedure, but it can easily be done as an office procedure like filler but with local anesthetic. Filler underneath the eyes is not permanent of course and in some patients results in adverse swelling.

You are still a candidate for fat grafting. Fat repositioning should have almost a 100% survival given it is attached to its blood supply. Fat grafting can also have a variable survival rate depending on technique and particle size. Best to see an eyelid expert.

At least from the original, pretreatment 2019 photos there appears to have been volume deficit in the cheeks. Since volume in the upper cheeks provide support for the under-eyes, when there is volume deficit the infraorbital area typically appears hollow with early bag formation as was seen. In this case, the use of a robust HA Volumizing filler for augmenting the cheeks can not only create a more feminine Ogee Curve and oval, heart-shaped face, but can help to diminish the hollows and bags directly under the eyes and establish a more gradual transition between upper cheeks and under-eyes.

The use of fat grafts at this time has a couple of downsides besides being expensive. First, the promise of permanent results is seldom realized, since changes in the surrounding muscle, skin and bones every few years with aging typically necessitates further interventions. It is also a two-stage, minimally invasive process using large cannulas to remove the fat from the donor areas in the thighs, buttocks or hips and injecting into the recipient areas. This usually means prolonged post-procedure downtime. Moreover, much of the fat that is transplanted, separated from its original blood supply in the donor area, does not actually survive. And finally, since the transplanted fat retains the characteristics of the area from which it is harvested, if the belly fat undergoes "midriff bulge" with aging, so can the belly fat placed under the eyes, which can be quite disturbing down the road.
You would be wise to seek consultatibn with an experienced, board certified cosmetic dermatologist filler expert and best of luck.

We have done a lot of eye bag treatments with fat grafting, as long as your doctor knows exactly how to work with it, you shouldn't have any problem, in fact as it's your own material is really rare to see a reaction to it. I cannot see your full face but it could be also be increase due to the volume loss on your cheeks. In my experience, treating this area you have really big improvements in facial, and specially eyes area, rejuvenation.

Midface volume restoration can be done a number of ways.
Surgeons have done this using fillers, fat grafting, using implants or a midface lift.
I’m not sure what your issue was with the fillers and fillers is probably the gold standard for this kind of work.
That said not, everybody has the same degree of skill when it comes to midface volume enhancement using fillers.
Consider looking at the website of Dr. David Mabrie MD in San Francisco.
Real self does not allow me to include a website link so you’ll have to look up his website.
David is a facial plastic surgeon whose career is focused exclusively on facial volume restoration using fillers.
His work is the best I’ve ever seen.
I’m not suggesting everybody fly to San Francisco to get fillers.
Seeing his results can be a powerful educational tool to understand what fillers can accomplish in the hands of the right provider.
Facial fat transfer is by its very nature, potentially imprecise, unpredictable, and potentially unforgiving if patients don’t like the outcome.
You can’t just reverse facial fat grafting.
It is an especially difficult in areas that have insufficient host tissue to support the grafted fat.
Facial fat transfer is by its very nature, potentially imprecise, unpredictable, and potentially unforgiving if patients don’t like the outcome.
You can’t just reverse facial fat grafting.
It is difficult in areas that have insufficient host tissue to support the grafted fat.
Especially around the eyes.
I generally do not recommend fat crafting in this area unless your provider has extensive experience with a proven track record.
Always ask providers to open up their portfolio and show you their entire collection of before and after pictures of previous patients with similar facial characteristics for any proposed treatment.
Perhaps you should be looking for another provider.
This kind of work is tricky and provider selection is in the end, sometimes the most important variable.
A midface lift may also be very helpful, but the procedure is pretty involved and has a potentially prolonged recovery time with facial swelling.
The procedure was more popular 20 years ago.
With the development of high-quality fillers, the procedure has taken somewhat of a backseat, but still has its place especially when done correctly.
Best,
Mats Hagstrom MD