Surgical Correction of Puffy Eyes After Pearl Fat Grafting? (photo)

I had Pearl Fat Grafting for hollowness under both eye lids from a Blepharoplasty done 2 years ago. Now, 6 months after pearl grafts, still no change and eyes are still puffy. I already had 2 surgeries from the inside of the eyes. How can I reduce or dissolve or have some removed? Is another surgery an option for me?

Doctor Answers 4

Prominent globe and hypoplastic cheeks

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The unique appearance of your face is characterized by somewhat flat cheeks and a very prominent globe. This is a very difficult situation aesthetically. The risk of repeat surgery to the lower eyelid is high, so each step must be carefully taken.

Our best bet is usually to combine a cheeklift performed through a minimal incision on the side of the eye, along with volume increasing grafts in the cheek area. While implants are an option, we prefer LiveFill grafts (nontraumatized fat-fascial grafts) in our practice.

The goal is not to change the face complete, just diminish the lower eyelid hollowness and contrast to the cheek area below, as well as to increase the harmony of the face overall.

At the time of surgery, it is recommended to surgically reduce the appearance of the lower eyelid grafts, and augment in adjacent, hollower areas.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Continued puffy lower eyelids after fat grafting

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In my experience the full effects of fat grafting isn't realized until about 18 months after surgery. From 6 months after surgery on you can find that the grafted fat slowly 'blossoms' as the new blood supply takes hold. I would probably avoid any revision procedure until at least 1 year after surgery in order to get an idea if any further improvement will occur. Fat graft take is very technique dependent and can vary widely among surgeons.

Your facial bone structure is challenging. Your upper jaw bone (maxilla) didn't grow very far forward and so created less lower eye socket bone support (causing the prominent eyes). This was made worse by fat removal during your original blepharoplasty. If your improvement is inadequate after your most recent fat grafting a repeat fat grafting procedure is an option. The goal would be to build up the soft tissue support in the lower eyelid/cheek area to help give better projection to this area. This would also camouflage the very visible lower eyelid fat pads.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

How to fix puffy eyes after fat grafting

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Fat grafting is a very powerful and effective technique when used around the eyes. In this area body, a small amount of fat will go a very very long way. It is possible that you may have had a little too much fat added to these areas. You may consider additional fat grafting to help camouflage them.

Fat transfer or Restylane may help under eyes.

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1) I am afraid you have a really difficult problem and need expert evaluation. You have under eye hollows and flat cheek bones. Expertly done fat transfer with or without a mid facelift may help.

2) Non invasive treatments may include Restylane for the hollows and Radiesse to build up your cheek bones.

3) Don't have anymore eyelid surgery. Too risky.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.