Will eyelid surgery and fat grafting improve hollowness and sagging?

Question

Hello, I have done lower eyelids blepharoplasty 12 years ago. I have sagging on upper eyelids and hollowness in lower eye lids. Do you think doing upper eyelids blepharoplasty and fat grafting to the lower eye will help to improve my eye area appearance ? Respond will be appreciate it. Thank you.

Nelson Lee Novick, MD · Answer

While the allure of a permanent result is certainly understandable, the problem with permanent fillers, like fat grafts, is that they are permanent and that adverse reactions to them, such as the formation of lumps and nodules can be very difficult to treat. What's more, In the case of fat grafts, since the fat grafts retain the characteristics of the region from which they were taken (i.e. belly, thighs, hips), with the passage of time, just as one can develop a midriff bulge, so can the fat injected into the cheeks.  
Regarding expensive surgery, here, too, the promise of a permanent result is seldom a reality (as you have already learned from having the prior surgery), since, with aging there are changes in underlying bone, fat and muscle that occur that turn an initial good results into an inadequate one often in just a few years. What's more, surgery entails not only significant post-surgical downtime, but also risks the development of scarring and even tram track stitch marks. 
A nonsurgical HA filler cheek augmentation using a robust HA volumizing filler can not only contour a more feminine, heart-shaped oval face and Ogee Curve, but can secondarily improve the under-eyes, since the upper cheek serves as an important support for the infraorbital region. 
As for the upper eye area, at least from the photos provided, it would appear that a few microdroplets of Botox properly injected in the lateral brow, along with a small amount of medium viscosity HA filler in the same region can help to elevate the upper outer lateral third of the eyebrows to create a more feminine flare to the brows and secondarily can help to raise the upper eyelids. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist injector expert, and best of luck.
Make sure to see an experienced, board certified cosmetic dermatologist. Best of luck.

Darryl J. Blinski, MD · Answer

I agree that your assessment after reviewing your photos is correct expect fees to range from $8000-$15,000. Best of virtual consult with.

Mats Hagstrom, MD (license on probation) · Answer

You don’t seem to have all that much excess skin on your upper eyelids.
It’s hard to evaluate your eyelid position to see if you have blocked peripheral vision based on static pictures.
This evaluation is better done in person.
Regarding midface volume, there are a number of ways to approach this.
That transfer is unpredictable and often fails to deliver quality outcomes because the area is lacking, in sufficient amounts of “host tissue” to support the grafted fat, this leads the fat graft to not survive where you need the volume the most.
fillers I probably considered to go standard for nonsurgical options.
For surgical treatments implants or a midface lift are potentially quality alternatives.
Implants have lost favor over the years and so has the midface lift to some extent.
A midface lift can give very impressive results for this condition which ultimately is based on facial, skeletal structure, much more than soft tissues, even though it may appear that the problem is soft tissue related.
I suggest having multiple in person consultations with plastic surgeons in your community.
This area is complex and inherently difficult to treat with consistent high-quality outcomes.
Insist on seeing lots of before and after pictures before considering potential permanent or irreversible procedures.
I don’t think that fat transfer is good for this part of the face.To get an understanding of what can be accomplished using fillers considered checking out the website of Dr. David Mabrie MD in San Francisco.
Real self does not allow me to include other website links in my responses so you’ll need to look up his website on your own.
It should not be difficult to find it with a simple Google search.David ‘s practice is exclusively devoted to treatment with facial fillers only.
He is a facial plastic surgeon, and in my opinion are the gold standard and the best I’ve ever seen in regards to what can be obtained using only fillers.
I’m not suggesting people flight to San Francisco to get fillers done, but seeing his results can be an educational tool to understand what can be achieved using fillers in the hands of the right provider.
Provider selection is in the end by far the most important variable.
Finding the right provider is much more difficult than most people realize.
 It’s a time-consuming process that requires having multiple in person consultations.
Best,
Mats Hagstrom MD

Will eyelid surgery and fat grafting improve hollowness and sagging?

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