Tear Trough Area Lump After Fat Transfer

I had fat transfer done in April 2008, and after two weeks, a visible lump formed on my right cheek and a larger bulge on my left side, but it's visible only when I'm smiling and laughing. Since then I seeked the advice of 5 other doctors, all unwilling to touch my face, all telling me different times (from 6 months to 3 years) to wait it off. What can I do besides waiting for months or years "to see" if it will go away? Can I get a proactive approach to a solution instead? Thank you so much.

Doctor Answers 17

Very difficult to give you a quick answer

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As the other doctors have mentioned, this could be a cyst, scar, hardened fat, etc. Fat transfer in the lower eyelid area can have great results, but can be very difficult to correct. It is wise to wait at least a year to see how this lump "matures." It should be treated based on how superficial and how deep it is. Some superficial ones can be cut out directly. Some deeper ones can also be carefully cut out. However, in some patients who have difficulty with nodules and lumps as a chronic problem, it is possible to put a thin sheet of tissue (fascia or Alloderm) under the skin and over these lumps to give a smoother appearance.

It is very difficult to say what to do unless you are seen. Having said that, most physicians would wait a year before doing anything. Find a good plastic surgeon in your area in Canada and let them follow you during this waiting time. Good luck.

Portland Plastic Surgeon

Revisional lower eyelid surgery

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

It is best to takes a stepwise approach

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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.

Amir M. Karam, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

You may need a revision.

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With fat grafting or any procedure, it is possible for you to develop "lumps," especially if you are being injected by an inexperienced injector. However, now that you have a lump it is best to wait some time before jumping into additional operations or procedures. These additional procedures are not without their own risk. It is important to seek the opinion of your surgeon and, possibly, other surgeons as you have. With out examining you myself, it is hard to give you specific advice. However, if you have seen 5 other surgeons and no one is suggesting an intervention at this time, I would tend to trust their advice. If you can find someone that says they will intervene, that may not be the correct answer. Most of these things improve with time, but I know that waiting is very difficult. Good luck.

David Shafer, MD
Shafer Plastic Surgery

Fat lumps in the tear trough -no easyway out

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The problem you hane is not unusual and  I have seen similarly affected patients who needed surgical revision. For some reason the fat injected in the perioorbital area tend to survive and thrive-  may be because of the rich blood supply. I beleive the the fat was injected under the muscle in your case and that is why the lump becomes prominernt  when you smile as the muscle contract over it bringing it in relief. This fat is going to be with you for good. Only reasonable and sure way is to have open incision bleparoplasty to clean it up and tighten up your lower lid.

Zain Kadri, MD
Los Angeles Facial Plastic Surgeon

Fat Transfer Lumps Can Be Treated

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Having lumps after fat transfer is not unusual. At this point if you are 2 years or more out from the procedure, it is defintely worth attempting treatment. The best treatment is dependent on a number of factors but your options range from intralesional steroid or 5-FU injections to microliposuction to thermal heating to surgical excision.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Fat Grafting Lumps When Smiling

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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

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Plan to wait one year!

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Contour irregularities after lower eyelid and/or cheeck fat injection can be very difficult to correct. There are a number of variable that affect this difficulty, including what level the fat was injected. If the fat was injected very close to the skin surface, this is more difficult. As I am not seeing you as a patient, I am not able to comment on your specific case but I can offer some general thoughts. I have treated patients in the past with fat irregularities after injection and I have used a couple of different approaches. For more superficial fat collections, this has required a direct removal, making a small cut over the area in question. For deeper irregularities, I have treated the fat deposits by going in through the inside of the lower eyelid. Unfortunately, either option requires a great deal of patience for the surgeon and the patient. I would recommend you find a board certified plastic surgeon in your area, who has experience with fat grafting. You can refer to surgery.org or plasticsurgery.org for a member of the American Society for Aesthetic Plastic Surgery or the American Society of Plastic Surgeons. Good luck and I hope things get better without needing more treatment!

Julius W. Few, MD
Chicago Plastic Surgeon

Sounds like a cyst or irregular placement of injections

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Fat should have the same texture and softness as the underlying fat. This is different than other fillers which are typically harder, and appear harder when you smile. Your description of seeing the lumps only when you smile suggests that the material is harder than the surrounding tissue. This could be swelling or a localized cyst. If it is just swelling then wait, if it is a cyst then surgical removal may be in your future. If you have the lump at all times, perhaps you need more filler.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Lumps and Nodules following Fat Transfer

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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.

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.