I have fat lumps in my lower eyelids after grafting. Is there anything I can do about it? (Photo)

Question

Had fat grafting for lower lids last year and ended up with fat lumps. Waited for 6 months and reconsulted with my surgeon (beverly hills). Fillers were administered, unfortunately the limps are still prominent. I feel like the surgery and the procedure dis not meet my expectations. Is there a solution to reaolve this matter? I would appreciate your professional reommendations.

Robert Glasgold, MD, FACS · Answer

It appears you have two issues, the lumps from fat transfer and fullness from restylane.  As a starting point it would probably be useful to dissolve the restylane with hyaluronidase and then evaluate. Lumps from fat can be addressed in one of two ways, injection to try to break down or direct excision of the lumps.  In terms of injection the two options are steroid (kenalog) or 5-FU.  In my experience kenalog is ultimately more effective.  Several sets of injections can usually reduce it and sometimes make it small enough that it is irrelevant.  If still persisting then they can be directly excised through an incision in the thin lower skin in the tear trough region.  The incision in this area heals great and you can also simultaneously get rid of redundant lower lid skin if needed.  Lastly, you should be aware that there may ultimately be a need to restore volume in the area to improve contour, which can be done with a delayed fat transfer or filler injection.

James Bonaparte, MD, MSc, FRCSC · Answer

Thanks for your question. I think you have two issues which are difficult to separate at this point. You have both fat and fillers in your lower lids.  I gather the main issue was the fat lumpiness and you've tried to correct this with the fillers. As you notice, this can or can not work. My personal opinion is that this rarely works perfectly. It can help, but often there are still irregularities or you trade one irregularity for another. To me, fat grafting in this area is unpredictable and because of the thing skin under the eye, you can certainly see lumps if it does not work perfectly. Some options include1) Removing the filler with hyaluronidase (dissolves the filler, but can be unpredictable as well)2) Use radiofrequency to shrink some of the fat (again, can be unpredictable)3) I would be cautious about using steroid injection around the eyes as blindness (although VERY rare, can occur). 4) surgery to remove some tissue, however again...it can make things worse. The key is communication with your surgeon, I really hope you solve the problem and all I can say is, stay positive the odds are you will get some improvement and be happy with your results.

John J. Martin, Jr., MD · Answer

Some times the fat will clump in the lower lids after a fat transfer.  Some massage may help to flatten this out, and ultrasound such as Ulthera can help to smooth out the fat. You have tried filler to hide it and that didnt' work. If it persists,  you will have to have it surgically removed.

Salvatore Pacella, MD, MBA, FACS · Answer

The Restylane should resorb over time, but it can take about 8 to 12 months.  You may want to consider some aggressive massage to help smooth the area if this is acceptable to your surgeon.  It is possible to disslove the filler with an enzyme, but the result can be unpredictable.  You may require a lower eyelid revision.  I would have a frank discussion with your surgeon about your concerns

Richard O. Gregory, MD · Answer

The problem that you have is not uncommon.  The situation is somewhat complex in that the two treatments may individually contribute to the problem and correction of these may be different.  Hyaluronic acid such as Juvederm and Restylane may be corrected with hyaluronidase.  Swelling and scar tissue may be improved by judicious injection of steroids.  Fat grafting which tends to be unpredictable because of the associated trauma to the rather fragile fat cells may lead to asymmetry and lumps.  This is somewhat more difficult correct.  In addition to the previously mentioned you may want to try ThermiSmooth radiofrequency treatment which can shrink fat.  As mentioned by others massage can be helpful.  Surgery would be a last resort as this may contribute to scarring and other problems.

Edwin Ishoo, MD · Answer

Unfortunately the picture you have posted is not helpful. What did you look like before any procedures? what did you look like before fillers. How long after the fat grafting did you do the fillers? How long after the fillers did you take this picture? have you had any other peri-orbital or facial procedures.Yes, you can improve the contour of fat grafted area with massaging but it will likely be slow and sublime. May need to wait until filler is resorbed or decide to treat it with enzyme which may also reduce the HA in the fat that was grafted. You can also talk to your surgeon about localized injection of corticosteroid such as Kenelog to cause localized lipoatrophy. I have not found ultrasound therapy such as Ulthera helpful for smoothing out lumpy fat, as its not designed or indicated for that use. Peri-orbital fat grafting is tricky. It has to be injected in a much deeper plane than fillers and if its superficial, it may be lumpy. Also, how was the fat removed. I prefer post-Vaser treated fat which is emulsified and just the right viscosity for this type of injection.

I have fat lumps in my lower eyelids after grafting. Is there anything I can do about it? (Photo)

Answers (6)

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