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

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. 

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.

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.