Overfilled fat transfer. Are fat dissolving injections effective, or do I need to have it removed via liposuction? (Photo)

Question

I have had fat transfer to the under eye but I’m worried it’s over filled especially the appearance when I smile, I’ve become extremely self conscious with this and needed some advice on what I can do to help correct this, is fat dissolving injections non effective against this? Or is my only option to have it removed via micro liposuction?

J. Timothy Katzen, MD, FACS · Answer

Hello,
Thank you for reaching out with your concern about overfilled fat injections in the lower eyelid. Based on your description, it's understandable why you're seeking a solution.
I advise against using fat-dissolving injections for this area. Such treatments can be unpredictable and may lead to uneven or distorted results. The delicate nature of the eyelid area requires a precise and controlled approach.
Micro liposuction, while it might seem like a potential option, carries significant risks, especially given the proximity to the eye. The risk of damage to the eye and the potential for asymmetric results makes this approach not advisable.
A safer and more controlled alternative would be a lower blepharoplasty, specifically through a transconjunctival approach. This procedure involves an incision inside the lower eyelid, allowing for the precise removal of excess fat. This method is generally considered safe and effective for correcting issues like overfilled fat injections in the lower eyelid area. The incision made in the inner part of the eyelid typically heals well, often without the need for external sutures, minimizing visible scarring.
I recommend consulting with a board-certified plastic surgeon or an oculoplastic surgeon experienced in eyelid surgeries. They can provide a detailed assessment and discuss the best course of action for your specific situation.
It's important to choose a solution that not only addresses the aesthetic concerns but also prioritizes the safety and health of your eyes.
Sincerely,
Dr. Katzen

Zoran Potparic, MD · Answer

Any kind of fat dissolving remedy is unpredictable and may couse irregular lumpiness. Conservative liposuction with small 1 mm cannula is one option, direct excision is other one. Only on the basis of in person evaluation one could give you more detailed list of options. You need someone very experienced to discuss this issue. Good luck.

Connie Hiers, MD, FACS · Answer

The injections could be tried, but they us usually do not remove a uniform amount of fat and this area is not forgiving. I would suggest the liposuction in a very conservatory fashion. Please discuss this with your surgeon.

Mats Hagstrom, MD (license on probation) · Answer

Facial fat transfer is by its very nature, imprecise, unpredictable, and potentially unforgiving if patients don’t like the outcome.
In order to make an equal assessment, we need far more information.
Facial fat transfer is by its very nature, imprecise, unpredictable, and potentially unforgiving if patients don’t like the outcome.
In order to make a quality assessment, we need far more information.
To make an assessment we need to see proper before and after pictures, and understand the timeframe of when your treatment was done.
Fat dissolving injections are also unpredictable and have potential serious side effects. This includes potential facial nerve damage that can lead to partial paralysis.
Reducing fat graft to the face is inherently, complicated and difficult and this is why I typically don’t recommend this procedure.
For those who do embark upon facial fed transfer a conservative approach with the understanding the patients may need a couple of procedures to build up to an ideal volume is a better approach.
 Your provider is responsible for your outcome, and I suggest you follow up with him or her.
I suggest you avoid the temptation of making your own assessment and prescribing your own treatments.
Because of the unpredictable nature of facial fat transfer, and its long and steep learning curve patients should be very selective when choosing providers.
RevisionBecause of the unpredictable, nature of facial fat transfer, and it’s long and steep learning curve, patients should be very selective when choosing providers.
Revision surgery is generally far more difficult and complex then primary procedures so being in the hands of the right provider, is by far the most Important variable.
To find the right provider I suggest patient schedule multiple in person consultations.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics to your own.
For revision work, ask providers to show you evidence of previous revision cases they’ve done.
 Obviously providers will have more examples of primary cases than revision work.
An experienced provider should have no difficulty showing you before and after pictures of at least 50 previous patients.
Highly experienced providers will in fact have access to hundreds or preferably thousands of before, and after pictures.
These are the type of providers you’re looking for.
Those who been doing The procedure successfully for decades with proven track record.
Ultimately your provider is responsible for your outcome and patience are responsible for choosing the right provider.
Being board-certified in plastic surgery with years of experience does not mean somebody is mastered anyone single procedure especially not highly complex procedures like liposuction and fat transfer.
Best,
Mats Hagstrom, MD

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