Is fat transfer under eyes the best option for me? (photos)

with mild deficiency in thin areas, I find fillers (belotero or restylane silk) to be safer and superior to the results obtained with fat.  No matter how finely harvested, fat remains much more particulate than the fillers, and more likely to therefore show thru the skin as a lump in very thin areas.  good luck

The junction between the lower eyelids and the midface it's a difficult area to not only assess but to treat.I will simply say it's complex.If you were to attend any cosmetic surgery conference you would see several hours devoted just to this topic.That is because there are several things that can be going on at the same time.In an ideal youthful face the skin of the lower eyelid and just below the lower eyelid is snog.It follows the contour of the Iottes self and there's no protrusion what is an medical jargon called Peri-orbital fat pads.In plain English this is often called the lower eyelid "bags".just below this is the transition or adjunction onto the midface.To midface hollowness or loss of volume that is seen as we get older is separate from the bulging of the lower eyelids just above.Are you full attractive face will typically also have lots of fullness in the mid face and cheek.So there are two opposing contour changes that happen as we age.That the line at the demarcates these two separate anatomic areas is often called the transition zone. Above the transition zone we want to see a tight contour with no bulging.Just below we want to see the opposite.The key to coming up with the correct treatment is to make the right diagnosis of which is a primary or secondary problem or both.Some patients will have protrusion of the lower eyelid fat pads but good mid face volume.These patients need a lower eyelid blepharoplasty.Patients without showing protrusion of the lower eyelid fat pads but who have tear trough or midface volume loss need volume.Thes patients do great with fillers or fat  to transfer.Many patients have both conditions going on at the same time.Of these patients many will turn to fillers because it will be recommended by someone who does fillers and Botox such as a nurse working in a doctors office or Medspa.volume restoration can give it nice results especially when the primary problem is volume loss.It can also help camouflage the bulging that some people have in the lower eyelids.when protrusion of the lower eyelid fat pads or lower eyelid bulging is the primary problem then adding volume is not the correct treatment.The complexity of making a correct analysis of this area cannot be over emphasized.It's not nearly as simple as desiring fat transfer because it offers a permanent solution to expensive temporary fillers.fillers are safe precise and easy to inject.Fat grafting just the opposite.It's unpredictable and technically much more difficult.There are limitations with fat transfer that are not seen when using fillers.Bad outcomes with fat transfer can also be exceedingly difficult and sometimes not possible to correct.On your frontal view you show shadows on the lower eyelids indicating some protrusion of your lower eyelid fat pads.If you're looking for a permanent treatment then you may do better with a lower eyelid blepharoplasty than fat transfer.In your case at trans conjunctival lower eyelid blepharoplasty might be a good option.In this procedure the fat is removed from the inside of the eyelid avoiding any skin incision or possible visible scar.This could be done in conjunction with some fat transfer or ongoing use of fillers.Some fillers last substantially longer than others giving a improved value.I personally like using Radiesse.I find it lasts at least twice as long as HA fillers like Juvaderm. Considering it's also substantially less expensive it offers an excellent value.my recommendation is getting a few in person consultations.Look for consistency in making an accurate diagnosis.The plastic surgeon should be addressing both the volume in your lower eyelids and the volume in your tear trough or mid face.Best,Mats Hagstrom M.D.