Restylane Vs. Fat Grafting for Under Eye Hollows?

I'm of East Indian origin and I have hereditary dark under eye circles. I have very thin skin under my eyes and a deep depressions in the inner cornes of my eyes and wrinkles. I'm trying to decide between getting Restylane injections to correct the hollowness or get Fat Grafting. I've read some pretty scary stories about both procedures and I'm not sure which is safer. Thank you

Doctor Answers 10

Far Grafting for under eye hollows - See Photos for evidence

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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 MD
Alpha Omega Alpha, Medical Honors Society
American Society of Aesthetic Plastic Surgeons
American Society of Plastic Surgeons
International Society of Plastic Surgeons

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Restylane is temporary and fat injections can last years

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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.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Restylane Vs. Fat Grafting for Under Eye Hollows

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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.

Fat injection vs Restylane

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Options for lower eyelid treatment

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Fat grafting involves taking live fat cells, protecting and processing them, and re-injecting or placing them in an area where more fat or bulk is needed.  In regards to safety for under eye correction, there is a greater possibility of irregularity of result with fat transfer than with fillers such as Restylane.  That is because it is difficult to place very tiny strands of fat under the very thin skin in the tear trough area, and therefore slight lumpiness is sometimes seen and is not desirable.  However, there is a way to combine fat grafting with lower lid blepharoplasty where the fat is injected underneath the skin into the bulk of the orbicularis muscle.  The procedures are safe under the hands of a a board-certified plastic surgeon with experience in these types of procedures, who is conservative in his approach.  It is important to discuss the various options available to you with your surgeon of choice.

James Carraway, MD
Virginia Beach Plastic Surgeon

Restylane vs fat for under the eyes

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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.

Filler vs. Fat injections

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews


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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 versus fat grafting in tear troughs

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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.

Solutions for Under Eye Hollows

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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.

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.