Age 27, will fat transfer fix this botched tear trough filler job? (Photos)

Question

Over the past 4 years I have had about 4 syringes of tear trough filler under my eyes by a top rated injector. As you can see, it still looks absolutely awful. These hollows are genetic, and very dark/purple coloured. They are my biggest insecurity and makeup cannot hide them. I am only 27. Will fat transfer get rid of these? Or an under eye implant? Please help.

Tim Neavin, MD · Answer

Thank you for the photos. I'd recommend nano fat transfer with PRP for the dermis, as well as micronized fat subdermally.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! The discoloration you're referring to can be very challenging. Do you have allergies? Sometimes, "allergic shiners" can cause this appearance and treating the allergies would help. Filler is often unsatisfying to improve this. Fat transfer will likely be underwhelming as well. In a case such as yours, I would have our aestheticians attempt topical treatments via lightening creams and possible IPL. I understand your frustration and hope you find some improvement.

Mats Hagstrom, MD (license on probation) · Answer

The transition between the lower eyelid and mid face is a treacherous very difficult area to do work that is a common area of complaint from patients.
In an ideal youthful face the lower eyelid should remain snug and tight with no bulging of the fat pads in the lower part of the lower eyelid. immediately below that area should be plump and full of volume.
People will come in for treatment and these areas need to be differentiated into whether it is the protrusion of lower eyelid fat, lower eyelid fat pads(there are three of them) being the primary problem or lack of a volume in the mid face immediately below. When are working adding volume with fillers it is absolutely critical that the volume doesn’t end up anywhere close to the lower eyelid fat pads which will make the situation much worse real quick.This line of demarcation of which above we try to have things look tight and without volume and below should have ample volume has had many different ways of being treated.
Most people who have would you describe typically have is the primary diagnosis a lack of projection of their mid face skeletal structure. If there’s any bulging of the lower eyelid fat pads then reducing those has always been one treatment option and it continues to do so. It’s best done with a trans-conjunctival lower eyelid blepharoplasty but could include a skin incision. For lack of midface volume the first treatments or the use of implants. In the 1990s before we had access to quality fillers and procedure called amid facelift was very popular. At one time a plastic surgeon name Malcolm Paul MD traveled around the world lecturing about this procedure but when I now look at his website it is no longer listed as an option. With the advent of fillers and refining techniques with fat to transfer the mid facelift fell out of favor. (A mid facelift is very different than a traditional facelift). I suggest looking at the website of Dr. David Mabrie MD in San Francisco. He has a facial plastic surgeon who has devoted his life exclusively to working with facial fillers.
Sometimes people think they are in the hands of the best provider but finding those who have truly mastered their art can be difficult and extremely time consuming.
Dr. Mabrie is someone who does the best facial volume restoration of anyone I’ve ever seen. His website has a lot of pictures and you may find some that have a similar resemblance to your own. Finding the right provider to work with is difficult and time-consuming. It requires having lots of in person consultations and reviewing a lot of before and after pictures.
Simply relying on before and after pictures that are presented which most likely represent the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider. this is why in my opinion if you’re trying to find the best provider patients I need to have in person consultations and during consultations ask providers to open up their portfolio and show their entire collection of before and after pictures. some may or may not be willing to do that but patients should at least try and ask the provider to show as many before and after pictures especially of patients with similar facial characteristics as possible. this should include examples of excellent outcomes, average outcomes and less than outcomes.
I don’t know what your geographic location is but traveling long distances for facial fillers isn’t something most people are interested in.
Still, getting an idea of what’s possible and what the gold standard is can be helpful.
One of the reasons that you found your experience frustrating is that it is inherently a difficult area to treat.
Many providers don’t understand the complexity and juxtaposition of the reversing values happening so close to each other regarding a tight lower eyelid and full mid face. Mastering restoring the volume in that interface between the two is simply challenging.
Best,
Mats Hagstrom MD

Richard P. Rand, MD, FACS (retired) · Answer

You need to be kinder to yourself and also realize that fat injections can cause permanent problems and that there are reports in the literature of blindness from tear trough fillers and aft. So please weigh this into your situation.

Age 27, will fat transfer fix this botched tear trough filler job? (Photos)

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