Best Way to Add Fat After Aggressive Lower Blepharoplasty?

What's the best way to add fat back into eyelid area after lower Blepharoplasty, for a smooth or blended look into the cheek area and lower eyelids? Is it better to put it back where it was taken out, from behind orbital septum? I know the fat that was taken out is different than any other fat in the body. Some doctors use Pearl Fat Grafting or Fat Grafting to give it fullness.

Doctor Answers 9

Needs to be put back into normal anatomical position

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Fat grafting needs to be put back into normal anatomical position, which is into the orbital septum. If it is put in the subcutaneous space it will be felt and possibly seen.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Fat transfer is very effective, but usually needs to be repeated

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I use fat transfer from the abdomen to the tear troughs and infraorbital rims, blending it into the upper cheek, routinely to correct this issue. It can be done with local anesthesia or IV sedation, depending on patient preference. I think that careful handling, use of fine injection cannulas, and gentle harvesting are keys to a smooth, natural result in this unforgiving area.
In my hands, 30-40% of the injected fat lasts a couple of years or longer, and 60-70% is gone within a few months. Hence, I overcorrect and counsel all my patients that they will likely need a follow-up injection in a couple of years. Most people have an adequate supply since so little is required for the lower eyelid area.

Anurag Agarwal, MD
Naples Facial Plastic Surgeon

Fat Grafting Lower Lids

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If the lower lids are hollow either by way of surgery or genetics, the treatment of choice is to add that volume-there can also be volume loss with the normal aging process. An easy alternative is to use fillers such as Restylane, Juvederm etc. to add volume. This is done in a chair under local anesthesia and recovery is very short- some mild swelling and possibly some bruising. However, these fillers last for a certain amount of time and will need to be redone two or three times per year. The injections should be deep to the muscle in order to avoid visible superficial blebs.

A longer lasting result can be obtained with fat grafting (fat transfer). I prefer to use a small cannula (2 mm) so that the little bits of fat transferred are small. This is important because the the smaller bits of fat vascularize faster and so live with the patient and last longer. If the fat pieces are too large, they will not survive, turn to oil and be resorbed. There is also a special technique for applying it so that is not visible- In general, the fat has to be placed below the muscle layer so that it will not be seen through the thin tissues of the eyelids.

Julio F. Gallo, MD
Miami Facial Plastic Surgeon

Lower Eyelid Hollow

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Dear Babyjoe, The hollow area under your eye can be filled with Restylane or with micofat injections. Restylane is done in the office with freezing/local and brusiing can last for 7 to 10 days. A very nice correction can be attained for 8 months to a year and a half. There are risks with this procedure- most common being prolonged bruising.

Micro fat grafting also works well and will be a permanent result. 1/5 patients needs a touch up at 2 months. This is a surgical prcedure done in the OR and there will be bruising for 10 days to 3 weeks.

With Warm Regards,

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Fat Grafting is effective for eye hollows

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In our experience, fat injection into the tear troughs and deformities after lower blepharoplasty are very successful with good "take" of the fat. If the fat grafting technique in the lower lid region is performed with utmost care, it is placed deep to the muscle layer right superficial to the bone. With conservative micro-grafting, you should see a significant improvement with one treatment but we ALWAYS educate our patients that it may require further sessions for best correction. Micro fat grafting is performed with a small cannula and the fat is placed as tiny deposits into the facial and eye hollows.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Micro fat grafting with good technique.

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Hi! This is unfortunately a fairly common problem that we see in New York. I assume you look hollow.

1) For most people with this post blepharoplasty deformity, fat injections are the simplest solution. The problem is that the success of fat injections is totally dependent on how it is done. There are literally a dozen technical details that are crucial. And of course there are no guarantees. But we generally see quite good results.

2) Some patients need repositioning of the remaining fat around the eyes, and some need a mid face lift.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Consider a Permanent Injectable Filler for your lower eyelids.

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Dear Babyjoe,

The hollow, operated-look you may have after lower eyelid fat removal is very common. For this reason, I almost never remove lower eyelid fat anymore.

I have had wonderful success rejuvenating the lower eyelid with Silikon-1000. This is a permanent filler that is FDA-approved for use in the eye, and can be used in an "off-label" fashion to put volume back in the face. Procedures are performed painlessly with topical anesthetic, and there is no downtime. It would likely take several treatments to get an optimal result, and complications are rare.

I have personally treated several patients with hollow lower eyelids after surgery, using Silikon-1000, and it has been satisfying for the patients and me.

Fat grafting is another consideration, but this carries more expense, and downtime, and is probably less predictable than Silikon, in my hands.

Let me know if I could be of further assistance, and best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

What you need is a surgeon not a technique.

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Dear Babyjoe

You may not need a fat graft to restore your lower eyelid. Photos would be helpful to know exactly what your issues are. I would be careful about what solutions are proposed to you and by whom.

Most people in your situation have been somewhat traumatized because they were genuinely careful in finding their first surgeon. Learning to trust a second surgeon can be difficult.

Generally what happens after aggressive lower blepharoplasty depends on precisely what approach was used, and the nature of your underlying lower eyelid issues. Approaching this generally what people typically seek lower eyelid surgery for is fullness in the lower eyelids from so-called pseudoherniated orbital fat.

This accounts for the big puffy fullness that can develop in the lower eyelids. To a lesser extent, lower eyelid wrinkles, lower eyelid laxity, poor cheek bone projection, under eye circles, and cheek festoons may also be concerns.

Under appreciated by both potential eyelid surgery patients and their surgeons is the role of midface descent and the relative contribution of poor cheek bone projection at the orbital rim. Failure to understand these factors and control for them is a common reason for disappointing lower eyelid surgery results.

Classic surgical paradigms for the lower eyelid surgery involve removal of fat from behind the lower eyelid called a transconjunctival lower blepharoplasty or from an incision made below the lower eyelid eyelashes called a transcutaneous lower blepharoplasty.

The transconjunctival lower blepharoplasty can be a good choice for the right person with appropriate sculpting of lower eyelid fat. However, when descent of the cheek fat is an important feature and too much fat is removed from the lower eyelid, the result will be an very hollow lower eyelid with exposure of the contour of the orbital rim.

The best solution in these situations is filling of the tear trough hollow with an adjustable filler like Restylane. The need for a more radical reconstruction with an orbital rim implant depends on whether the lower eyelid contour was also compromised by surgery.

Generally fat grafting even with so-called pearl fat grafts is a disappointing approach to correctling the problem.

Dr. Steinsapir

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

Eye cheek junction after blepharoplasty

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The best way to efface the eye cheek junction and reduce post-blepharoplasty hollowness in most cases is not, in my opinion, to perform fat grafting alone.

Rather, a minimally invasive cheeklift is performed, elevating the thicker cheek tissue in addition to placing grafts.

If you look closely, there is often a distortion of the lateral eyelid as well that should be treated. Many patients notice that after conventional subciliary (under the eyelid) blepharoplasty, that their eye shape changes and their eyes become more rounded. This postsurgical change can usually be improved with a superficial minimally invasive cheeklift (i.e . LUSIC (TM) cheeklift as well.

Fat injection and any periorbital fat injection or grafting has a relatively high risk of producing minor irregularities or lumpiness that are difficult to treat, so great experience, conservatism and a well developed aesthetic sense are necessary in the surgeon.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

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.