Is It Possible to Put Back Fat After Lower Blepharoplasty?

Question

If the doctor takes out too much fat during lower blepharoplasty, making the eyes hollow-looking, is it possible to put back fat in the area? If so, what are some options for getting this done?

Vincent N. Zubowicz, MD · Answer

If too much fat has been removed after lower lid blepharoplasty, fat grafting can restore the volume. In the past, aggressive removal of fat was considered proper technique. As perspective was gained on results, the removal of fat has become much more conservative and, in some cases, unnecessary. Occasionally, miscalculation can occur and the patient may end up with a "hollowed out" look. Replenishing fat deep to the orbital septum can help.

Thomas A. Lamperti, MD · Answer

By using fat grafting techniques fat can be gently removed from another part of your body (e.g. abdomen, thighs, hips) and then injected into the hollowed out area under your eyes. Fat grafting in this area is very technique-dependent so you will want to have it done by someone who has extensive experience with this.

Michael A. Persky, MD · Answer

Hi Babyjoe,
Yes it is possible to perform fat transfer to the lower eye lid area after a blepharoplasty if it is felt that there is too little volume left.  One should wait a few months to allow swelling to resolve and all healing to take place.  The procedure is done with fat transfer and micro-fat injections.
Good luck and be well.
Dr. P

Mark Berkowitz, MD · Answer

If too much fat is removed during lower eyelid surgery (blepharoplasty) there are methods to refill this area. Skilled cosmetic surgeons can transfer fat removed from other places in the body to the lower eyelid area. Prior to under taking this or as an alternative, fillers like Restylane and Juvederm can be used to refill this delicate area. Fillers in this area can last as long as 18-24 months. Preventive measures are best. Choose a skilled Ocular Plastic or Cosmetic Surgeon to perfom this procedure. When I perform this procedure I am very conservative in the removal of fat. I actually sit my patients up during the surgery to judge the amount of fat removed!

David Shafer, MD, FACS · Answer

Babyjoe, If too much fat was removed during a blepharoplasty, it is possible to perform fat transfer/grafting operations. It is also possible to augment the area with a dermal filler such as Juvederm (HA) or Evolence (collagen). However, you need to see someone who knows what they are doing when injecting around the eyes. Also, if you are immediately post-op, please be patient since you will see changes over several months after surgery and it would be a mistake to rush into anything too such. Good luck.

David C. Mabrie, MD · Answer

Fat replacement is not a commonly performed procedure, if ever it is performed at all. Fillers may be placed under the eyes to help smooth the surfaces.

	 

	For more examples of Dermafillers injected to the eyes, Click on the link below.

Chris Thiagarajah, MD · Answer

Yes it is possible to place fat back into the lower eyelids after blepharoplasty. Sometimes the fat can be repositioned. Other times the fat can be harvested from another site. It really depends on what the problem is to find the best solution.

William Portuese, MD · Answer

Yes, there are fat grafting techniques that can be performed. The fat needs to be put back into the proper anatomical position and into the orbital septum and not into the subcutaneous skin. If it is placed in the subcutaneous area it will look like a glob of fat in the wrong location.

Michael Law, MD · Answer

Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
I often perform structural fat grafting on upper and lowere eyelids on patients who have had overly-aggressive surgery perfomed by another physician that has left them looking hollow.

Peter E. Johnson, MD · Answer

I'm sorry to hear that you are disappointed after your lower blepharoplasty. The trend in blepharoplasty has been less fat removal for several years now. Instead, we attempt to strengthen the septum in the lid which holds the fat back and prevent future hollows. As we age we lose facial fat and the skin and muscle thin giving the eye an open hollow and aged appearance. This can occur many years after a lower blepharoplasty and conservation of fat is key to help prevent future aging.Fat removed can be replaced with a technique of structural fat grafting to the lower lid. Very often in younger patients we add fat to the lid rather than surgery to correct contour and soften the line where the cheek and lid meet. This nonsurgical lid rejuvenation has been very successful and become quite popular in our area.The popularity in fat grafting in the lower lid has caused a spill over into temporary fillers. I caution against fillers in the lower lid as the tissue is very thin and imperfections are common. Discoloration has also been a source of disappointment with fillers, and of course they are temporary.Fat grafting placed deeply in the lid gives a very smooth and natural result and is quite lasting to permanent. I also caution against over-correction or over-filling in the lower lid as these grafts often do not change.

Is It Possible to Put Back Fat After Lower Blepharoplasty?

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