Puffy and Hyperpigmented Under Eye Area After Pearl Fat Grafting

I had hollowness in my lower eyes from a Blepharoplasty that was done 1 1/2 yr ago. I went to a few doctors in NYC who said putting fat back in the lower eyes is easy, but fat grafting the eyes may look lumpy. So I started looking for doctors online, and found one who does this and he says he's a specialist in this. I had Pearl Fat Grafting done through him 2 months ago, and my eyes went from hollow to puffy. I don't like the way I look, and I don't see the puffiness going down, yet he said it takes time. He told me i also had tear trough deformity, which i noticed before he did anything. I also have hyperpigemention under my eyes, which got darker after the procedure. He said it will fade in time. The photo below shows a day pre-procedure, and 6 weeks post-procedure. This doctor always tells me "give it time", but I'm concerned because I have to go back to work soon, and I need something that can help me as soon as possible. What are my options for getting these fixed?

Doctor Answers 4

Fat grafting to lower eyelids

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Fat grafting by any technique is a tricky process for the lower eyelids. Grafts take a long time to incorporate, metabolize and stabilize. most surgeons perfoming a great number of lower eyelid revisional cases wait six months before assessing the final results. However that does not mean you should not be seeing your doctor for microadjustments during that period; this is important as well.

With a negative vector face, prominent eyeballs and flat cheeks, the problem with the lower eyelid is especially difficult. Some surgeons recommend soft tissue augmentation of the cheek area, in our practice with LiveFill, along with a superficial cheeklift to reduce, but not eliminate the problem.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Unfortunately need to wait at least 6 months

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It is generally believed that after fat transfer you won't get a sense of what fat will have survived the procedure until the 6 month mark. At that point, if more needs to be placed, or some needs to be diminished, appropriate steps can be performed.

Just by your pics it's hard to know if removing fat or adding more to the area below the puffiness would be appropriate. So unfortunately, waiting is your best option.

Min S. Ahn, MD, FACS
Westborough Facial Plastic Surgeon
4.6 out of 5 stars 35 reviews

Sorry, but patience is the key

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Unfortuneately, you have a common stigmata after standard blepharoplasty, which is hollowing under the eye. 6 weeks post-procedure is still very early and you will need to wait months to know what your results will look like. Generally speaking 20-30% of fat will survive, but sometimes none of it does. Every patient is different. Often times injecting any type of fillers into this area will cause the pigment under your eyes to become more noticeable because the skin is very thin. Fortuneately this hyperpigmentation is almost always temporary. I would talk to your surgeon periodically. Massage may also help reduce swelling and speed up your recovery time. Good luck.

Samson Lee, MD
Seattle Facial Plastic Surgeon

No easy answer; Consider fillers

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There is no easy answer here.

It is possible that your fat grafts will persist and remain firm.

However, it appears that your cheeks and body rim remain untreated with relative lack of projection as discussed by Dr. Moelleken and termed the "negative vector" look.

For the most immediated option, I would advise fillers to the tear trough, infra- orbital rim, and malar eminence as experienced by Lucetted in the comments section. I would advise the use of Juvederm, but an experienced injector can do well with nearly any filler.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

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.