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

Question

My under eye areas are sunken in and the tear trough line is very noticeable, especially when I smile (the skin then looks "crepe" like). I wanted to know if fat transfer would be the best option for me (I don't want the constant maintenance/cost of fillers). I'm also curious about cost (I would be willing to go anywhere in the Toronto area). I tried to take pictures at angles to show the sunken in parts as best as I could.

Kurtis Martin, MD · Answer

The best solution for a tear trough deformity is to use hyaluronic acid fillers. These are potentially reversible and do not cause lumpiness. They can however cause discoloration of the lower lid which can appear as a soggy gray area. Fat grafting of the lower lids can result in permanent lumpiness of the lower lids.

Mehryar (Ray) Taban, MD, FACS · Answer

Fat injection under eyes is one option but it may or may not be the best option.  Others options include filler injection and possible lower blepharoplasty. Best to see an oculoplastic specialist for in person evaluation.

Mathew A. Plant, MD, FRCSC · Answer

Without examining you it is difficult to be certain but I would still recommend hyaluronic acid based fillers. Fat transfer is unpredictable and you can end up with very visible lumps under your eyes because the skin is so thin. Fat transfer to other areas of the face is great, but for the lower lids I am personally finding Emervel (the new product from the makers of restylane) to be amazing at treating tear troughs without any lumps or irregularities. When you are older and a candidate for a blepharoplasty then your surgeon should consider fat redraping as this is much more predictable. The only way to know for sure is to book a consultation with a board certified plastic surgeon near you to see what your options are. Best of luck!

Marwan R. Khalifeh, MD · Answer

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

Mats Hagstrom, MD (license on probation) · Answer

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.

R. Stephen Mulholland, MD (retired) · Answer

Dear jen6987,

There can be many causes for loss of
volume under the eye, hereditary tear troughed deformity or lower lid hollowing
or lower lid hollowing from trauma or simple aging.  Aging is usually a combination of deflation
and descent of the mid face with unmasking of any lower lid volume with or
without the presence of lower lid fat pad herniation.

As there are several causes to
infraorbital volume deficiency there is also several treatments.  Plastic surgery is not a specialty of black
or white, but of many shades of grey and often many different ways can yield an
excellent aesthetic result.  If the true
diagnosis is one of loss of volume then replacement with volume is your best
option.  There are many options,
therefore, Hyaluronic acid sugar gels such as Restylane, Belotero or Juvederm
have the advantage of being reversible and if there’s an embolic event there is
some potential for salvage.  Long-term
fillers that stimulate a host of responses is Radiesse, Sculptra or even
Artefill or Articol have the advantage of being long-term, but can also result
in fibroplasia or non-salvable embolization and necrosis. Restoration of lower lid volume with
descendant or deflated mid face structures can be remedied with mid face
elevation techniques.

Your photo does not show the rest of
the face, but you do appear to have a fairly youthful lid and this is likely
more of a hereditary paucity of lower lid volume and this is an area I have
found to be treated quite successfully with micro fat grafting techniques.  Fat like all techniques comes with risk and benefits,
but in hands that have performed a lot of the procedure in the infraorbital
buttress it can be an excellent option. 
It has the potential of being very long-term and the risk of lumpiness
done properly is exceedingly low.

Variable resorption is likely much
more of a greater risk than lumpiness.

I think a consultation with an
experienced plastic and oculoplastic surgeon with lower lid volume restoration
is your next step. I hope this information is of some
assistance and best of luck.

To find out more, please visit the
link below.  Also visit the areas on fat
grafting. To schedule a consultation simply
fill out the online consultation form or call the number on the content page
and a client service representative will get back to you shortly.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

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

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