A Twofold Question Regarding Fat Transfer After Restylane to the Tear Troughs

I am 23 and have always had hereditary dark circles caused by tear troughs and very thin lower lid skin. 2 months ago I had restylane done. It did slightly improve the contour, though I have a dent under one eye and the darkness from underlying vasculature and muscle is still there. Now I'm hoping fat might be an option as it isn't clear. Can I have fat transfer to the area with the restylane so recent? I'm also trying to find a dr in Atl that is known to be skillful with this delicate procedure

Doctor Answers 9

Fat Transfer for Tear Troughs Will Not Correct Dark Skin Color Need IPL or Laser

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Thank you for your question.

Fat Grafting will plump the depression of the tear trough and reduce the shadow causing the dark circle.

However if your dark skin color is caused by blood vessels and thin skin the fat transfer wil not change the skin color. IPL in fair skin individuals or Fractional Erbium 1540 Laser in dark skinned individuals, can often help discoloration caused by vessels or pigment.

Fat transfer to tear troughs

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I agree that fat typically makes a better material for augmenting the tear troughs and cheek hollows but i would recommend that you allow the Restylane to wear off before performing the fat transfer

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

It is possible to have fat transfer to tear troughs shortly after Restylane

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I have performed tear trough fat transfer, with or without concomitant lower blepharoplasty and laser resurfacing, in patients who have had Restylane or Juvederm Ultra in their tear troughs. The process is actually very straightforward - we simply reverse their filler through a hyaluronidase injection several days before surgery (generally when the patient comes in for the informational/consent session).


Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

Fat to eyes

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I think it would be best to delay it a bit till the restyene is gone.Fat is a good option and a light peel might provide enough bleaching to get rid of soem of the color you have.l

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

Fat transfer for dark circles

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Be very careful.  Hereditary dark circles are hard to correct consistently.  Fat, like any material placed close to the skin in the eyelid, can cause lumpiness that may not be correctable.

Restylane is a safer approach for this area.  It lasts approximately 6 months.  If the first injection did not improve the contour, you may need more injected.  Find someone locally who is comfortable injecting this area.

Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon

I would not give up on the Restylane.

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I seen many patients who find me to help them with an unsatisfactory lower eyelid fat grafts.  This very thin area does not hide grafted fat very well.  The fillers is the right approach.  Three are several issues.  First it does not sound like your under eye filler service has been adequately performed.  Does it need to be adjusted with hyaluronidase or do you simply need more Restylane.  One of the most common filler issues I see, it that the original surgeon did not use enough filler.  As you have learned, this service is a bit of an art form.  You need an artistic injector.  Once you find the right injector and get the right service, this is a much safer more reliable method of dealing with the dark circle than fat grafting will ever be.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Fat Transfer under the eyes.

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   Dear Emorel,

     Fat can certainly be transferred under the eyes. Fat can be used all over the face to improve loss of volume. I personally feel that Fat is much better transferred under the eyes than using facial fillers to fill that space. I think the fat gives a more natural look and fullness than say Restylane. I would have to see you in person to fully decide on how best to treat your eyes. Fat can be transferred into recent Restyalne filled areas, though Restylane and other fillers can be dissolved with injections of enzymes, it would depend on the Doctor's preference. Unfortunately I do not know anyone to refer you to in GA, but good luck on your journey.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Making tear troughs and dark circles better

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Adding or replacing volume to help deep tear troughs is certainly one way to help this difficult problem. However, it is usually a multiple procedure process to get the best look. Don't forget to consider fractional resurfacing as well as volume replacement when trying to smooth these down. Also, you are 23 and will have to deal with anything done, for the rest of your life. Take the time to consider carefully the risks, benefits and alternatives of whatever is suggested.

Barry Resnik, MD
Miami Dermatologist

Fat transfer after Restylane

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Sounds like you are on the right track. If you are serious about having the fat transfer I would recommend being treated with Wydase, hyaluronidase, beforehand. This will dissolve the Restylane and allow your surgeon to see and correct the entire groove a once.

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.