I have under eye hollowness post blepharoplasty with laser tightening. I'm 6 months out from my lower lid blepharoplasty and have the dreaded hollow under eyes. Can Fat grafting or fillers work? Which is better way to go? How do I find an MD with good technique that I can trust? What is the downtime? (I am a fair skinned northern European male who does not want to wear makeup Thank you!
Fat Transfer or Fillers for Under Eye Hollowness?
Doctor Answers 15
Fillers work for under eye hollowness.
Various fillers do good for under eye hollowness but expect it to be done in 2-3 sessions a week or 2 apart. Juvederm or Restylane ($550 per syringe) usually needs 2-3 syringes. Diluted Radiesse ($650 per syringe) usually needs 1-2 syringes. Fat injections are very variable and can look great initially but get lumpy as they disappear in 6 months ($1500-2500 per session) and are done every 3-4 months.
Treating under eye hollowness post blepharoplasty
Hollowness alone is best treated by injectable fillers, Juvederm or Restylane if the patient cannot or does not wish to have surgery. This is a fine solution, and if patients don't mind the temporary and changing nature of filler injections, it is an excellent solution. In fact after any type of surgery, no matter how comprehensive or successful, fillers help to iron out small irregularities and hollow regions.
Fat injections are indeed often lumpy and their survival is not always predictable, resulting in asymmetries.
If there has been drooping of the cheek, raising the cheekpad can hide the eye-cheek junction. This is called a cheeklift, and in order to effect changes in the lower eyelid area, this should be performed through the lower eyelid. Our preference is to avoid the orbital septum completely and perform a minimal incision (termed USIC cheeklift, an ultrashort incision cheeklift).
A cheeklift has the ability to raise the thicker cheek tissue to an area below the eye, diminishing the appearance of hollowness below the eye. Rather than placing a graft of fat injection, which is mostly dead, we place an autologous graft of fat-fascia specifically at the eye-cheek junction and conservatively into the tear trough to minimize the appearance of hollowness.
This is especially successful in the post-blepharoplasty eye where there has been a change in the eye shape such as rounding of the eye or pulling down in the corners of the eye.
So one more option for you to consider.
Fat vs Filler for Lower Lid Hollowing
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Fat transfer to lower eyelids
You can use either a filler or fat. However, I personally like the results with fat better since it looks and feels more natural. Fillers are useful as a first round of evaluation. If you are happy with the result, you cna then move to a more permenant result with the fat.
Fat and fillers work well for under eye hollowness
Fat injections and fillers (Restylane, Juvederm) are both excellent ways to address the lower eyelid hollows. I prefer fat as it has a longer lasting result that is very natural. I use the fillers for patients who want to "try it out" before they commit to fat injections. Often, I combine fat injection with lower blepharoplasty for a more complete result. This eliminates the kind of result that you are complaining about. Good luck!
Fat vs fillers for under eye hollows
Fat is a wonderful natural filler, especially in relatively young people and may take as a permenant graft. However, a word of caution, successful fat grafts can change with your weight. - so if you loose a lot of weight the correction may be lost, and if you gain weight, it may become lumpy. Fillers are a good way to find out how the correction will look with out having permenancy, and my choice in that area is Juvederm. It usually lasts 9 months to 1 year. Most dermatologists or surgeons who do liposuction will do fat transfer.
Treatment of post blepheroplasty hollowness can be treated by either modality fat transfer, or Hyaluronic acid filler.
What is important is the experience of the surgeon doing the injection, simillar to the blepheroplasty, the results are dependant on the experience of the surgeon.
Fat Transfer or Fillers: In Your Case Fillers
I tend to use fat transfer as a permanent panfacial treatment, i.e., over the entire face for several reasons.
1. Although in my hands, fat transfer is permanent and smooth (non-lumpy), the take under the eyes can be variable in the sense that it can look better but may not be all the way filled. I think by forcing the fill, you take a risk in having problems, which I don't do.
2. Therefore, when I do full face work, if one area is not as perfect as possible, then the face still looks great. That for me is the principle I call the 5% rule. If 20 small facial areas look better but not perfect with fat, the face looks better. That is the trick.
Therefore, in your case, when people just want lower eyelid fills, I tend to steer them away from fat and move them toward fillers.
That is my opinion.
Dr. Sam Lam
P.S.: A video on the 5% rule.
Fat grafting or fillers for under eye hollows
If your lower lid is hollow after surgery, fillers may improve your look. I prefer to use Restylane or Juvederm for this area, and place it underneath the muscle. This is an off-label use of the filler but many physicians do see great results. Lumpiness may occur, especially if the filler is placed above the muscle or close to the eyelid margin, and possibly a greater chance of lumps with fat than the hyaluronic acids such as Juvederm and Restylane.
Restylane or Fat to Fill Lower Eye Hollows?
I would recommend having Restylane injections by an experienced and skilled physician. The results are long lasting, and even when the Restylane has been reabsorbed, the remaining hollow is less than the original hollow. It is thought that Restylane stimulates your own collagen production.
If you should tire of getting Restylane injections, then find an expert fat transfer surgeon for this most delicate and unforgiving area.
Good luck and be well.