Why do I have bags one year after a lower blepharoplasty with fat transfer? How can they be fixed? (Photos)

Question

One year ago I had a 4-lid blepharoplasty with fat transfer to the tear troughs, but now I look like someone who would benefit from a lower blepharoplasty rather than someone who had one. Previously I never had any filler, fat transfer, or other surgery. Following the initial swelling of surgery, it was immediately clear that some lumps were remaining (or new lumps formed?) under both eyes. The right under-eye area was especially swollen for months, and my surgeon told me to wait it out. The residual swelling did go down after about 4-5 months, but these firmer arc-shaped bags remained. The right under-eye bag is very visible at all angles and in all light. At about 10 months after the surgery, I saw the surgeon again to ask him about the remaining bags, noting that the more prominent one under the right eye was especially bothersome. He felt it with his finger and said “That’s bone,” which really took me by surprise. I later noticed that the bags move vertically when I contract my muscles, so I don’t see how they can be bone. Finally I consulted with a different plastic surgeon who examined both sides and said that those bags are fat and that a second blepharoplasty would be necessary to improve them. If these bags are fat, were they caused by the fat transfer or was some of the existing fat left behind? Or is it not fat? Can these bags be improved?

Guray Yesiladali, MD, FEBOPRAS · Answer

A clear and final assessment can only be made after a direct examination. Photographs and descriptions are helpful, but they cannot fully reveal tissue quality, structural support, or how the nose behaves on palpation and breathing.
When revision surgery is being considered, timing is just as important as technique. In most cases, the most appropriate window for a revision is after the second postoperative year. By this point, swelling has fully resolved, scar tissue has matured, and the nasal structures have stabilized, allowing for a more predictable and refined correction.
Waiting until this stage reduces unnecessary intervention and improves the likelihood of achieving a durable result.
I hope this provides helpful guidance as you consider your next steps. Wishing you patience through the healing process and clarity when the time is right to decide.

Kyle Kimura, MD · Answer

Thank you for your questions and photos. 
First of all, I'm sorry that you're having to deal with these issues after surgery. Here are my thoughts:
- I agree with your second surgeon that those areas look like fat bags and not bone. Whether it is from your fat transfer or just residual fat is hard to determine. The other thing to consider is excess fluid which can develop sometimes after a fat transfer. - I think this could certainly improve with a revision blepharoplasty and possibly some type of laser resurfacing to tighten the lower lids. 
Hope this helps and best of luck!Kyle Kimura, MD

Stephen Prendiville, MD · Answer

Thank you for your question.  The first piece of advice that I have is to discuss your concerns and potential remedies with your Surgeon.  Since my take on lower lid blepharoplasty is a little different than what many Surgeons believe, my bias is that your will need a revision.  The eyelid cheek junction or orbicularis retaining ligament needs to be released and re positioned with a SOOF lift to address the concerns that you have. Filling this area is very difficult to do in a satisfactory fashion.  Therein lies the issue with your concerns.

Albert Yang, MD · Answer

Hey, it is hard to give you a diagnosis on picture alone but 1. It could be residual fat - should be soft and will pooch out when you look up - Tx: lower bleph 2. It could be graft fat - it will feel bulgy and roll around your finger. - Tx: a little harder to fix but lower bleph and remove the graft fat would be the way to go.

Darryl J. Blinski, MD · Answer

Based on your nicely post of photos, I would recommend the Endo laser treatment 1 to 2 sessions under local anesthesia each session $2500 range. Best of virtual consult with.

Why do I have bags one year after a lower blepharoplasty with fat transfer? How can they be fixed? (Photos)

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