Tear Trough Area Lump After Fat Transfer

There is nothing wrong with waiting until a problem is stable, and at that time reassess critically to see if any revision surgery needs to be done. Usually this timepoint is some time after six months.
Fat injection fat can sometimes be aspirated with a very fine liposuction canula. In my experience, however, this is sometimes touch since the fat that does survive tends to be very "gristly" and does not aspirate well through a canula. Sometimes the adjacent native fat is more vulnerable to the suction and well intentioned suctioning of the tougher fat injection fat can actually cause irregularities that compound the initial problem, not improve it. Usually when we revise the lower eyelids and have irreguarities from prior fat injection grafts, we remove them through direct incisions.
At the time of any revision, we assess for why the patient had the fat injections in the first place. Was there hollowness in the lower eyelid area? Was there drooping of the cheeks that could benefit from a cheeklift? There are many types of cheeklifts, so which one? Would the patient benefit from moving up the thicker cheek tissue slightly to cover the lower eyelid hollowness?
Will the patient be better and more simply served with volume replacement with temporary Hyaluronic acid filler? Or a nontraumatized fascial fat graft such as LiveFill placed directly into the tear trough or eye-cheek junction?
All these revision procedures have risk with them, so we have a candid discussion on how bad the problem really is, and whether revision surgery is even indicated.
The lower eyelids are the most delicate area in the entire body, for fat injection or any other procedure because of the extremely thin lower eyelid skin and the difficulty in correction of problems if they do occur.

  You need to find an oculofacial plastic surgeon who is willing to help you.  I would check the directory of ASOPRS.  I would consider conservative steroid injections or surgical excision if necessary.  Good luck!

I agree with the advice of the other physicians you consulted for several reasons - not all fat survives and sometimes the fat necrosis/liquefaction process of fat cells that do not survive will create inflammatory lumps or nodules that overtime will self correct or can be aspirated if liquefied. On the other extreme, you will not know if this is because too much fat was injected until several months.The bottom line is that many factors are at play and waiting is the best medicine. Massage may help and will allow you to feel that you are part of the healing process. After 6 months to a year your condition should stabilize and your surgeon can direct you as to what if any procedure might be corrective.

Without examining you or looking at a photo, it is hard to give you sound advice. But, the first step is to find an experienced fat transfer surgeon who performs many treatments around the eyes. As a general conservative approach, the first step is often direct micro-aspiration during the early phases (i.e. within a month). The fat is still soft and can potentially by suctioned out. This can be coupled with massage, but massage alone rarely treats the problem completely unless it is subtle.
Next step would be to inject the fat with a very dilute steroid. Often this will take several treatments. This is a delicate area so it is important the injections are done very conservatively and placed in the correct levels to avoid complications. Unfortunately, if the lumps are because of too much fat placed into a given area which resulted in a raised lump, many times it will require a direct excision through a small skin incision. Depending on the location, it can be done through a blepharoplasty incision, but often times, a direct incision over the lump is more effective. But if the size is diminishing with time, then I would certainly advice waiting it out.

Hi Femme Fatale,
Sorry to hear that you are suffering from fat graft complications. Most importantly you should continue following the advice of qualified and experienced fat transfer surgeons.
Accent XL is a non-invasive method of sculpting fat. It may be possible to smooth your "lumps" with a series of treatments. This area is extremely delicate. Your evaluation should be performed by someone with a great deal of experience.
Microliposuction may help if there is a palpable mass of fat.
Dr. Few has given you very good advice. Patience and waiting as the five docs that you have consulted with won't get you into any additional trouble.
Hopefully your problem will resolve soon. Be well.
Dr. P