Under eye fat transfer overfill ten years ago - can this be fixed? (Photo)

Question

Hello, I had fat transfer under eyes 10 years ago and they were overfilled is there anyway to fix this,the older I get the worse it looks?

Carl Truesdale, MD · Answer

Ten years is long enough that what you see now is what you'll have unless we intervene. The fat that took has integrated permanently into the tissue, so it behaves like native fat.
The treatment options depend on what the lump actually is:
If it's stable, visible bulk in the under-eye area from grafted fat that took successfully, the cleanest option is surgical removal. Through a transconjunctival incision (no external scar) the surgeon can directly excise the overgrafted fat. This is straightforward in experienced hands and gives a definitive result.
If it's more diffuse fullness rather than a distinct lump, dilute steroid injection (Kenalog) can selectively atrophy fat over a series of treatments. Slow and requires precision but avoids surgery.
If there's any uncertainty about whether it's fat versus filler residue versus scar, an in-office ultrasound or MRI before doing anything irreversible can clarify. I've seen patients who thought they had fat overfill actually have an old filler deposit that was still dissolvable.
For best results, find a surgeon who does under-eye revision specifically, not general facial plastic surgery. The lower eyelid is unforgiving and a surgeon without specific revision experience can create more problems than they solve.
One more thing. If your skin quality has changed in the decade since the original procedure (loose skin, fine lines), a combined lower blepharoplasty with fat repositioning at the time of fat excision can address both issues with a single recovery. Worth asking your surgeon if it makes sense in your case.

Frank Agullo, MD · Answer

Ten years out is plenty of time to know it isn't going away, and you're right to be looking. Had a patient last year in the same boat. Fat grafting under her eyes from a different surgeon over a decade ago, never melted down, made her look perpetually tired. We took her to direct microsurgical excision through a small transconjunctival approach. She was back in makeup within a week and the area looked normal at six weeks.

Direct excision is usually the most predictable choice for grafted under-eye fat, because that fat is now her tissue, fully integrated with its own blood supply. Microliposhaving with a small cannula works when the overfill is soft and diffuse. I have seen great results with AccuTite.

This is delicate work. Not where you save money. Find a plastic surgeon or oculoplastic surgeon who has specifically removed grafted fat in this area before.

#StayBeautiful,

@RealDrWorldWide

Rachelle Eljazzar, MD · Answer

While it is difficult to tell based on this image alone, you seem to have evidence of what is called malar edema. Essentially, the undereye area has a disruption in the lymphatic drainage and therefore fluid accumulates resulting in what is referred to as malar edema. This is substantiated if you notice that it gets worse throughout the day (if it was from the fat placement alone, you would not expect it to fluctuate). It is an uncommon but potential risk from fat grafting, though most often associated with filler placed in this region. Treatment is often multimodal but RF with microneedling as well as skin resurfacing with a laser or peel would help improve this appearance. If it is truly from excess fat cells placed during grafting, this is a bit more challenging and could potentially require lower blepharoplasty with attempt for excision.

Yily De Los Santos, MD · Answer

Yes, in many cases it is possible to improve excess volume under the eyes, even many years after fat transfer. Over time, tissues change, skin loses elasticity, and what may have looked acceptable before can start to appear heavier or more irregular with aging.

The most important step is determining whether the issue is true excess fat, fat displacement, chronic swelling, or natural aging changes around the eyes. Each cause is treated differently.

When overcorrection is present, one option may be carefully reducing or removing some of the fat. In some cases, improving skin quality or repositioning tissues is also necessary to create a smoother and more natural transition between the lower eyelid and cheek.

The under eye area is extremely delicate, so revision procedures require a very precise and conservative approach. The goal is not to make the area completely hollow, but to restore balance and softness.

Under eye fat transfer overfill ten years ago - can this be fixed? (Photo)

Answers (4)

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