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-year-old fat transfer is interesting because by now you've reached your long-term steady state. The fat that took has integrated permanently, and any visible overfill is what your body decided to keep.
There are two practical approaches.
Surgical removal. Through a transconjunctival or transcutaneous lower lid approach, the surgeon can directly excise the residual fat from the orbital area. This is the most definitive answer and works well when the fat is in a discrete pocket. Recovery is 7 to 10 days. The risk is over-correction creating hollowness, so you want a surgeon experienced specifically with secondary lower lid work.
Microliposuction. Sometimes a small cannula can be used to thin overfilled fat in specific areas, especially if the fat is more diffusely distributed. Less invasive than open removal but requires very fine technique to avoid creating contour irregularities.
A few things to know:
If the overfill is mixed with old filler (some patients had both layered), an MRI or ultrasound can help map what's there before any procedure.
If there's also any skin redundancy or fine wrinkling from the bulk, the surgical approach can address all at once.
Avoid more filler on top of the existing fullness. This often makes the visual worse and creates a more difficult revision down the line.
Find a surgeon who specifically does secondary lower lid revision. The dissection plane after fat transfer is different from a virgin lower lid and matters for safe correction. Operative reports from the original surgeon are useful if you can get them.

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 - Account Suspended · 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 - Account Suspended · 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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