Restylane Vs. Fat Grafting for Under Eye Hollows?

Fat injection, even in the best of hands, has the chance for lumpiness. This lumpiness can be difficult to correct. Especially in young patients we prefer Prevelle or Restylane.

Both fat and Restylane can be used to fill out hollows under the eyes.  Fat has the advantage of being permanent but is a bit more unpredictable.  For those who want quick fixes with little to no downtime, Restylane is the appropriate choice.  For those who want more volume and permanent results with added downtime, fat is the better option.

Although you may have heard scary things about both procedures the incidence of them happening is quite low. That being said the potential bad things that can happen from fillers are generally less severe and usually reversible when compared to fat transfer.
You are young and your lower lid contour is relatively good. I would recommend beginning with filler. You don't burn any bridges and I beleive you will be pleased with your result.

Restylane or Juvederm, both hyaluronic acids, are commonly used, off-label (not FDA approved for this use, but doctors may legally perform the procedure) for this purpose.
Fat injections may give you a good result but, there are different ways that both of these fillers are done by different doctors. Some inject over the muscle, and there may be larger chance of visible bumps.
The nice thing about Restylane or Juvederm is that if there is too much filler injected, it can be dissolved by injecting hyaluronidase. This also can be used in case of serious complications, such as a plugged blood vessel, whereas there is no equivalent of hyaluronidase for fat injections.

The key is not the procedure but who does the procedure.  Either might be appropriate for you -- and they are not the only options.  There are other fillers, biostimulators and devices that might be approrpriate.  The addition of the right cosmeceuticals can also make the difference in your results.  My recommendation is that you seek a consult with an experienced physician board certified in a core cosmetic specialty like dermatology.  Review your concerns and your goals with her and have a clear discussion about your options, risks  and benefits.  I hope this helps answer your question. Best wishes.

If there is enough of a hollow under the inside of the eyelid this is referred to as the tear trough region. Filling the area  with either fat or dermal filler(Hyaluronic acid) helps most patients with the shadowing. The advantage of a dermal filler is the smoothness of the injection. Using a microcannula the filler can be placed just above bone as the syringe is withdrawn. Fat grafting  is performed also with a blunt microcannula. The technique is also  made easy today since there is specific ways to prepare the fat. Both methods work well. There is some degree of permanency of fat injections so therein lies an advantage. Conservatism of treatment is the ticket. You can always go back and add more. It may be wise to warm up with a filler before going to fat grafting. It is a matter of preference and the recommendation from your physician.

Both procedures are safe if done by a provider with experience in tear trough fillers. Fat is a more permanent option, as Restylane only lasts about 6-12 months under the eyes. I recommend doing non-permanent fillers first to see if it meets your expectations. Then if you are satisfied with the results, you can opt for a more permanent filler, such as fat grafting.

Look at the experience and photos from a plastic surgeon before deciding who you will trust with your health and appearance.
A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume, are naturally thin or hollow, or have developed noticeable and bothersome lines and creases. The most popular fillers currently are hyaluronic acid products like Juvederm® and Restylane® which can be used to, among other things, plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). In this practice we have performed thousands of injections with these safe and reliable hyaluronic acid fillers. They are well-tolerated by almost all patients and they produce very few post-injection problems. The improvement generally lasts from four to eight months, the average being about five to six months. Of the available hyaluronic acid soft tissue fillers, I have been most pleased with the performance of Juvederm®.
Other injectable fillers are currently available which attempt to produce a longer-lasting soft tissue augmentation by incorporating substances that are more slowly metabolized or that cannot be metabolized by the body. These are sometimes referred to as 'semi-permanent' fillers. Some incorporate non-degradable biologic materials (e.g. Radiesse®, which contains calcium hydroxyapatite, the mineral component of bone) or non-biologic (synthetic) materials (e.g. ArteFill®, which contains polymethyl methacrylate, also known as Lucite) that are designed to persist in the body permanently. Another is Sculptra®, which consists of a synthetic polymer called poly-L-lactic acid, which is also used as an absorbable suture material.
Unfortunately, the body treats these materials as foreign objects, and as a result the placement of non-degradable and synthetic materials may lead to inflammation, infection, migration and granuloma (an inflammatory cyst) formation - none of which are problems that you want to experience near the skin surface in your face. In general, the 'semi-permanent' injectables containing these materials are less likely to produce a result that looks and feels natural, and because of the potential complications I feel that they should never ever be injected anywhere close to the skin surface. We do not use any of these injectables in my practice.
If you are looking for a longer-lasting result than you are getting with Juvederm® or Restylane®, we have a much better solution for you: you own fat, currently residing somewhere that you don't need it. The improvement is designed to be permanent, and your body will not treat it as a foreign object. Your immune system won't attack it. The cost is about the same as several syringes of a 'semi-permanent' filler. And the quality of your facial skin may, in fact, actually improve in the areas where fat is grafted. 
Michael Law MDAlpha Omega Alpha, Medical Honors SocietyAmerican Society of Aesthetic Plastic SurgeonsAmerican Society of Plastic SurgeonsInternational Society of Plastic Surgeons

Restylane is temporary but is more forgiving in that it can be molded.  Fat is permanent but may cause more lumps that are more difficult to deal with thatn restylane.

Restylane will last about 6-9 months but can improve this area. Fat injections can last 8-10 or more years. You are one the right track though. You need volume in this area and that's the best way to improve this area. One thing to realize is that restylane will go away and can also be taken out earlier if you wish through enzyme injections. This can be reassuring.
Fat injections are more permanent and is a little harder to get rid of if you don't like the volume but can be done through different special procedures. In my opinion, fat injections / transfer leads to the most natural results.