Large Eye Bags After Fat Injections on Lower Eyelids

I had a midface suspension (midface lift) and upper Blepharoplasty 16 months ago. My lower eyelids were fine, I had no bags. My doctor kept injecting fat into my lower eyelids ONLY (2.5cc, 3cc, 1.5cc) over 6 months, saying he was injecting it under my eyes to help my mid-face. I did not have hollow eyes and my mid-face was fine after the surgery, but I had these huge, huge bags under my eyes and had to undergo a lower Blepharoplasty which I never needed before. Where is fat supposed to be injected?

Doctor Answers 5

Fat injection lower lids

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Fat injection salong the tear trough and lower orbital rims is the goal. However, sometimes it gets lumpy and doesn't take evenly. 

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Facial aging has many components

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Many people think that facial aging is limited to skin drooping, wrinkles, furroughs, uneven complexion but few realize that this is only 30% of the problem. Fat also disappears from the face and the facial skeleton looses its robust support. Your surgeon should assess all three layers in order to formulate a "flight plan" for you, which you, ultimately have to understand and accept.

Structural fat grafting is used widely to restore the youthful fullness, especially in the cheeks, temples, lateral brow pad and lips. I have used it once, on the dorsum or bridge of the nose, with great results. The periorbital zone is one, which I have avoided because the skin is so thin that any excess volume will be magnified. I usually use a hyaluronic acid filler because I feel it's easier to dose. The good news is that hyualuronic acid lasts over 6months in this site.

Another caveat about fat grafting to the face, it has to be harvested and grafted as gently as possible and placed into a zone, which is adequately vascular. I have had disappointing results with fat grafting in vegetarians and very thin individuals. Something about their metabolism, the fat just melts away. good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 reviews

Injections to the tear trough of the lower eyelid

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 The tear trough is the proper location of injections to add volume to the lower lids.  This is the deep groove right along the bone rim.

Lower Eyelid Bags

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Fillers such as the patient's own fat are used to fill depressions along the bony rim of the eye socket. Many times the mid-face lift will actually fill those grooves. On other occasions fillers are placed in addition to the lift, preferably at the same time. Certainly this can be done after the original procedure.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Fat injections in lower eyelids need to respect individual anatomy

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Hello SXSW,

Autologous fat injections can be a very effective procedure for correcting and augmenting the lower eyelid / nasojugal groove areas.

Without knowing exactly what kind of midface lift you had or seeing your pictures, I am going to have to make some assumptions here. Based on your history, if your lower eyes never had "bags" then I am going to presume that the fat was injected in order to provide a smoother transition between the lower eye area and upper cheek area after the midface lift was done.

Basically, as the midface tissues are elevated, you can see creasing or bunching or depressions in the transition zone between the area where the lower eyelid / boney orbit stops and the malar / cheek area begins. Fat injections can be used in small amounts to specifically address this transition zone.

In other cases where there is a true concavity (depression) of the lower eyelid, fat can be injected to correct this. It is important to recognize each patient's unique anatomy in order to inject the fat at the right level. In most cases the fat should not be injected just under the skin since it can be readily visible and appear "bumpy" (an exception would be a patient with very thick eyelid skin who only needs small amounts of fat injected). It should also never be injected deep to the orbital septum (a layer of tissue that holds back the fat that surrounds your eyeball).

Another option is to reposition existing fat into areas of concavity (this fat is referred to as the SOOF).

As you can see, lower eyelid anatomy is complex and variable -- that is why the right area to inject will vary from patient to patient depending on the anatomical issue at hand.

Thank you for your question.

Kamran Jafri, MD
New York Facial Plastic Surgeon

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.