How to fix bad lower bleph & fat transfer 6 months post-op? (Photos)

Question

I had lower bleph w CO2 laser 6 mo ago. Surgeon did fat tx to my lower lids despite me saying I wanted transposition if needed (I didn’t have hollows). The result is disappointing and aged me. My eyes are sunken and the highpoint of the undereye is now my tear trough (instead of being flat) because too much fat injected where not needed, and too much removed right under my eyes. It looks like I have a constant black eye and craters under my eyes when I smile. Is there anything that can be done?

Pawel Szychta, MD, PhD, DSc · Answer

I'm sorry to hear that you’re experiencing such disappointing results after your lower blepharoplasty and fat transfer. It sounds like the fat transfer was overdone in certain areas and that there may have been excessive fat removal from under your eyes, which has caused an imbalance and aged appearance.
At six months post-op, there are still options available to improve your results. Here’s a breakdown of possible next steps:1. Fat Dissolving or Removal - Hyaluronidase or Steroid Injections: If the fat transfer included hyaluronic acid fillers (which is rare for fat transfer but possible in some cases),*hyaluronidase can dissolve the filler and restore a more balanced contour. - Fat Dissolution: If true fat was transferred and injected inappropriately, steroid injections or deoxycholic acid (Kybella) may help dissolve some of the fat. This is a more gradual approach but could help reduce some of the excessive fullness in the tear trough area. 2. **Revision Lower Blepharoplasty - If too much fat was removed under the eyes and there are hollows or sunken areas, a revision lower blepharoplasty might be necessary to redistribute fat or further refine the contours. In your case, it may involve fat transposition&mdash;which you initially requested&mdash;or using small fat grafts to fill the deficient areas under the eyes. - The revision can also address any scarring or irregularities caused by the initial surgery.3. Fat Grafting to Correct Volume Loss - In the case where too much fat was removed (causing hollows or sunken areas), fat grafting could restore some volume. However, it needs to be done with great precision by an experienced surgeon to avoid overcorrection again. - The key here is to use small, precise amounts of fat or consider using dermal fillers as a temporary solution to see how you like the results before committing to another fat transfer.4. Dermal Fillers - If you want a less invasive, temporary fix, dermal fillers can help correct the sunken areas and smooth out the craters or irregularities. - An experienced injector can use a micro-cannula technique to place the filler very precisely, avoiding the risk of overfilling. - Fillers also allow you to assess if adding volume improves the look before considering something more permanent.5. Laser Resurfacing or Skin Tightening - Since you already had a CO2 laser treatment, it’s possible that there was some degree of skin tightening. However, further laser treatments or radiofrequency could help smooth out any irregularities or address skin texture issues that were exacerbated by the initial surgery. - These treatments can also improve skin elasticity and help reduce the appearance of fine lines or the "crater-like" effect when smiling.6. Consult with a Specialist - Oculoplastic surgeons or facial plastic surgeons with expertise in revision blepharoplasty are the best to consult for this kind of problem. Revision surgery is often more complex, so you want someone highly skilled with a track record of successful corrections. - Look for someone who specializes in fat grafting and revisions to avoid repeating the same issues.
It’s a challenging situation, but with the right approach and an experienced specialist, you can improve the outcome and restore the natural look you were hoping for.

Mats Hagstrom, MD (license on probation) · Answer

The lower eyelid contour as it transitions into the upper midface is difficult to both assess and treat adequately.
There are a lot of different variables happening at the same time.
I’m not a big fan of fat grafting, especially in this area though it is done frequently.
 Grafting tends to be unpredictable, and precise and potentially unforgiving if patients don’t like the outcome.
Quality assessment quality.
Ask your provider to forward a complete set of proper before and after pictures and use those.
Fillers are unlike fat, grafting, precise, predictable, and also forgiving if patients don’t like the outcome.
In my opinion, fillers are the gold standard for facial volume enhancement.
Simply making a quality assessment and understanding the problem is not always easy or straightforward.
There are several tissue variables, causing opposing volume changes immediately adjacent to each other in this area.
Provider selection is the most important variable. potentially even more important than what technique or procedure is being used.
Best,
Mats Hagstrom MD

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