To go for fat grafting or not: Why do some doctors warn against fat grafting under eyes and some agree to do it?

Question

There are some very contradictive views among the doctors on this matter. Is someone able to explain why?

Jonathan Kulbersh, MD · Answer

Thank you for your good question. While fat grafting can offer more durable results, it can also be more unpredictable than fillers. If it is not injected properly in this delicate area, it can lead to lumpiness that is very difficult to correct. Only very experienced, board-certified plastic surgeons should perform fat grafting in this area. Fillers tend to produce smoother, more consistent results overall, even though you will need to repeat the procedure periodically to maintain your results.

Thomas A. Mustoe, MD, FACS · Answer

Fat grafting is fairly permanent ( usually lasts many years) and so if it is not done smoothly or too much is added fixing a problem can be challenging. On the other hand fillers which are more commonly used can occasionally cause chronic swelling due to fluid in the tissues (edema) which is resistant to treatment.  Filler is also not as “soft” and often doesn’t look completely smooth.I have done fat grafting underneath the eyes in hundreds of patients over 15 years and feel confident that it gives excellent results but experience and optimization of technique has made a huge difference in the consistency of my results.  Choose an experienced surgeon.

Jason Emer, MD · Answer

fat can be used well for under eyes, and full facial volumization with fillers to fine tune.  I suggest seeing an expert.
 I would suggest a combination approach of for facial rejuvenation:
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel, Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
Best, Dr. Emer.

Timothy A. Janiga, MD, FACS · Answer

Fat grafting underneath the eyes can be challenging but quite beneficial because it can provide long lasting volume enhancement.  It is important to have a surgeon that has vast experience with fat grafting.  Fat grafting that is done poorly can be difficult to repair.  It is important to be conservative in this area. I have performed hundreds of fat grafting procedures with excellent results.  Take care.Timothy A. Janiga MD, FACS

Mark T. Boschert, MD · Answer

The procedure itself done well works fantastic. The reason that you get different responses is different surgeons have different comfort levels and abilities. I would go see someone who is comfortable with the procedure and they will likely be the ones were getting great results with it. Best of luck! Dr. Boschert

Mats Hagstrom, MD (license on probation) · Answer

The reasons you see different opinions is because this procedure creates a variety of outcomes based on different variables. The primary reason the outcomes are so different is based on the skill of the providers and the candidacy of the patient.It is in my opinion somewhat unpredictable and imprecise. For the transfer does well in certain circumstances like giving diffuse overall volume and not nearly as well in very precise correcting volumes in small areas.The difference in outcomes among different providers is also so great that as an overall statement I’m not a big fan of this procedure.When done correctly by someone who has an immense amount of experience and talent it’s a great procedure.I see too many people posting on real self asking how previously grafted and fat in the face can be removed. I also know how difficult it is to remove previously grafted fat.As well, I know how superior fillers are to fat except for longevity that fillers are simply a better option if outcome is important.It’s simply a difficult procedure to do well consistently. Facial aesthetics is difficult enough.As is true with so many things in this field find the right provider and everything falls into place.Finding the right provider is far more difficult to do then people believe. People look to social media and end up with self promoters rather than true experts.You’re fine controversy in opinion with conditions that don’t have great treatment options, when there are significant negative potential outcomes or variations in treatment choices.Fat transfer around the eyes is particularly challenging for all of the reasons stated above.My practice is devoted exclusively to liposuction and fat transfer and has been for the last decade.I gave up facial fat transfer many years ago because of its finicky nature, unpredictable outcome and patients  insistence on perfection that simply wasn’t possible using this technique.Best, Mats Hagstrom MD

James Fernau, MD, FACS - Account Suspended · Answer

Hi and thank you for your question. Fat grafting under the eyes can cause lumpy spots if not injected properly because the under eye area is so thin and delicate. During the process of fat transfer, we have to not only harvest good quality fat from other areas of the body, but we have to make sure it continues to stay of good quality during the transfer. Then, we have to properly inject it, and even the most experienced doctors have trouble doing this just because fat grafting under the eye is so unpredictable. Fillers are the way to go. Best of luck to you--and please see a board-certified surgeon for your concerns.James L. Fernau, MD
Board Certified Plastic Surgeon
American Society of Plastic Surgeons (ASPS)
The American Society for Aesthetic Plastic Surgery (ASAPS)
International Society of Aesthetic Plastic Surgery (ISAPS)
American Society for Laser Medicine and Surgery (ACLMS)
Fellow American College of Surgeons (FACS)
American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)
The Rhinoplasty Society

Richard P. Rand, MD, FACS (retired) · Answer

Placing fillers and fat in the lower lids has been reported to cause blindness in some patients in the world literature. Is the small risk even worth it?? Also, if you have irregular or lumpy take of the fat it can be very hard to correct.

To go for fat grafting or not: Why do some doctors warn against fat grafting under eyes and some agree to do it?

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