Fat grafting for lower eyelid blepharoplasty? (Photo)

Fat grafting done in the right hands is a powerful and effective procedure. The amount of fat survival varies depending on the size of fat particles, amount of injection, and technique used. Typically I would remove some eyelid fat in combination with fat grafting.

Fat grafting is a very common procedure to perform with lower bleparhoplasty. Fat resorption and lumps are not common- especially if this is a procedure the surgeon performs frequently.

I recommend a lower blepharoplasty. This releases the septum and allows the fat to flow down. You can add fat later. As you have read, not all fat survives and can lead to contour irregularities.

Best Wishes,

Gary Horndeski, M.D.

At least from the photos provided there appears to have been volume deficit in the cheeks. Since volume in the upper cheeks provide support for the under-eyes, when there is volume deficit the infraorbital area typically appears hollow with early bag formation as was seen. In this case, the use of a robust HA Volumizing filler for augmenting the cheeks can help to diminish the hollows and bags directly under the eyes and establish a more gradual transition between upper cheeks and under-eyes. Besides expensive, the use of fat grafts at this time has a couple of downsides. First, the promise of permanent results is seldom realized, since changes in the surrounding muscle, skin and bones every few years with aging typically necessitates further interventions. It is also a two-stage, minimally invasive process using large cannulas to remove the fat from the donor areas in the thighs, buttocks or hips and injecting into the recipient areas. This usually means prolonged post-procedure downtime. Moreover, much of the fat that is transplanted, separated from its original blood supply in the donor area, does not actually survive. And finally, since the transplanted fat retains the characteristics of the area from which it is harvested, if the belly fat undergoes "midriff bulge" with aging, so can the belly fat placed under the eyes, which can be quite disturbing down the road. You would be wise to seek consultatibn with an experienced, board certified cosmetic dermatologist filler expert and best of luck.

Personally, I’m not a big fan of facial fat grafting, especially in the upper midface around the lower eyelids.
Facial fat grafting tends to be a bit unpredictable, potentially imprecise, and also potentially unforgiving if patients don’t like the outcome.
Make sure you ask to see lots and lots of before and after pictures.
I also typically recommend having multiple consultation before selecting a provider. Midface volume restoration can be done in a number of ways. I typically recommend fillers because they are more predicable, precise and much more forgiving if you don’t like the outcome.
Anytime we contemplate facial fat transfer we need to consider how the fat is going to be removed if the outcome is problematic.
For facial fat transfer you want someone who truly specializes in this procedure. It is more tricky in areas that are devoid of tissue to support the grafted fat. It’s more likely to be problematic in areas you need the volume the most.
Best
Mats Hagström MD