Need fat graft revision/removal of tear troughs, lumps and bumps.

It's very hard to reverse facial fat grafting. Sometimes this requires liposuction, face lift with fat removal or repositioning. I find that small changes can be made with ultrasound, radiofrequency or kybella/mesotherapy/lipodissolve, or 5fu steroids. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer.

Unfortunately you have a difficult problem with no easy resolution.  The hard lumps are fat necrosis and scar, and  I have had some success with repeated needling of the area to break up the scar combined with dilute steroid placed into the area at the same time. For severe cases I have had to resort to direct excision either through a blepharoplasty incision, or sometimes directly.  You obviously had way too much fat added, and probably by a technique using larger cannulas which cause more problems with unintended boluses of fat.  If the areas are soft, I have had some success with liposuction with very fine cannulas, but that will have no effect on areas that are hard.

This is a high complication area, you have the classic deformity often seen with fat grafting of the lower lids. The problem is removal of the fat. It is very had to do while  keeping the lower lid smooth, frequently you trade one problem for another. Steroid injections don't work and have side effects. Surgery is not very satisfactory unless all the fat has been placed on the bone where it easily be gotten to. Kybella is an injectable product which dissolves fat and can be used here, though there is very little track record of using the product in the lower lids and I would wait until there is more experience with it.  Lasers and ultrasound don't reach deep enough to get to the fat. No easy answers.

Indeed this is a difficult situation as everyone (truthfully) has the fear that we can make things worse. Surgical oculoplastics may have a solution. One method we are exploring is using targeted RF to reduce fat focally, no way of measuring the amount of energy needed to destroy fat. HIFU is too powerful, so low wattage RF maybe a viable solution. Regards, Dr Davin S. Lim. Brisbane. Australia.