Would fat transfer be a solution for my under eyes? (Photo)

Thanks for your question on an important topic. As you know a large part of the aging process comes from hollowing that happens around the eyes as the orbital rim enlarges with age and we loose some soft tissue. What I notice on your face is that the lower lids are sunken in mainly above the lower bony rim, you have relatively high cheekbones (assume you have some filler there) and hollowing of volume in your temples and brows. Your experience with filler is common: quick metabolization and in many cases lumps bumps and discoloration. Fat has the benefit of being from your own body and being longer lasting, however it has it significant risks too: 1) It is unpredictable so it is tough to get it to perfect with one shot as you don't want to over fill because 2) If you get an overfill, lumps or bumps they are much more difficult to deal with than hyaluronic acid filler. I would say you need to go to a very skilled, experienced person that has a long track record of peri-ocular fat grafting to get prices and opinion. What you need to know is that unlike filler, the fat takes about 6 months to start showing its effects so you need to have patience and be ready to do a second round to get as close to perfect as possible while staying in a safe zone that minimizes risk of complications. I would also recommend volume concurrently to your temples and brows for overall facial harmony. Best of luck!

Hello, and thank you for providing photos along with your question. While fat transfer injections are effective in treating sunken areas under the eyes, you may also consider lower blepharoplasty for more comprehensive eye rejuvenation. Lower blepharoplasty is an eyelid surgery that creates a smoother transition from the lower eyelid to the cheek. There are many technical variations that your surgeon might use during a lower blepharoplasty to customize the eyelid procedure and address concerns such as loose or wrinkled skin of the lower eyelid, excess puffiness or bags under the eyes, loose or sagging eyelid, and loss of volume in the cheek. And since the procedure involves removing skin or repositioning fat, lower blepharoplasty offers long-lasting results. To determine your eligibility for the procedure, schedule an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon can do a proper evaluation, customize the best treatment plan, and ensure the best possible outcome.

You probably would benefit from a lower lid blepharoplasty with fat injected into the tear trough and under eye area. Fat transfer without a lower lid blepharoplasty will probably not give you the result you want. And a lower lid blepharoplasty without fat transfer may end up making you look too hollowed out. Please see someone with a lot of experience it with fat transfer and lower lid surgery.

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer​​​​

Yes nano fat grafting to under eyelid hollowness would be an alternative to using HA fillers. Expect fees in the $5,000 ranges. Seek in person or virtual consultations.

Fillers are precise, predictable and forgiving. Fat transfer is not.

The only advantage that fat transfer offers is permanence.

If patients do not like the outcome then grafted fat can be very difficult to remove once grafted. Grafted fat survives based on a number of variables but perhaps most important is the presence of host tissue to graft into.

The mid cheek lower eyelid interface is tricky and tends to be very thin. The soft tissue thickness gradually changes and grafted fat can be unpredictable in this area.

For that reason I would recommend fillers as a superior option despite having to redo them on a regular basis.

Consider working with Radiesse which lasts about twice as long as HA-based fillers or products like Voluma which tends to give longer lasting results.

To get a good assessment and better understanding of all treatment options I suggest having in person consultations with experienced and talented local board-certified plastic surgeons or facial plastic surgeons.

Fat transfer is an option but it should not be thought of as an equivalent permanent version of fillers because it is not.
Best,

Mats Hagstrom MD