I have dark eye bags.
Do I need both fat graft for tear trough and orbital fat removal?
Hi, I have dark eye bags, and my surgeon is suggesting fat graft for tear trough and orbital
fat removal.
I am wondering if I really need BOTH?
I am also worried about over grafting / over removing (as doing one of the two makes the
other less obvious already).
And are the results of both permanent with no side effects?
My doctor also says he will not remove excess skin (doesn't think it's needed), even though
I think my skin is loose.
Would be great to hear from doctors here, thanks!
Thank you for your question!
You submitted a single very limited photo of your eyes and you’re stating that you’ve
gone to a surgeon who’s recommending the reduction of orbital fat as well as the fat
grafting to deal with the relative hollows and dark circles.
You also gone to write that you feel that there’s extra skin under your eyes even
though your surgeon disagrees with you.
And so now you’re looking for additional opinions.
Well, let’s first understand that anyone who performs surgery of any kind has their
own approach and style and certainly, you can’t necessary disagree as a colleague
with someone else’s approach if in their hands, it works well for them.
I will share with you my opinion based on my experience on what we do in our practice
and the basis of why I make the choices I do.
I’m a cosmetic oculofacial plastic surgeon.
I specialize in eyelid surgery, facial rejuvenation surgery, hair loss treatment.
We have several areas in our practice where we do a lot of work in and eyelid surgery
is one of the things that we do a lot.
The challenge we have with a combination of either anatomy or aging or both is the prolapse
of fat occurring with this at the same time as relative hollowing.
So from my experience, I find that addressing the fat pockets, the prolapsing fat and doing
something like a transconjunctival blepharoplasty is significantly improves the appearance of
tired and hollow looking eyes.
I always tell my patients to think of what is causing the tear trough area to look so
deep.
Well, adjacent to that deep trough is a mountain.
So the contrast between the elevation and the depression is further accentuated.
My hesitation with the use of fat transfer as your surgeon is advocating is based on
a lot of experience where the fat is not predictable.
And I don’t think that any surgeon would ever state that they can 100% guarantee within
reasonable amount that they can really deliver the fat they really want to deliver the way
they want it to take.
Because you have to understand it’s a graft.
It means that it’s been taken away and it’s separated from another part of the body, let’s
say the abdomen, and placed under the eyes and we’re anticipating that a certain amount
of blood supply will allow the fat integrate and become viable.
What happens is that 30-70% of fat will actually absorb.
And from my experience, a lot of fat will actually become inflamed and become scarred
creating irregularities and lumpiness.
So in our practice, what we typically counsel our patients to do is we’ll do the lower
eyelid puffiness.
Most of the time, people don’t need excess skin removal so I think you’d be okay without
that and we’ll do something called platelet-rich plasma to try to improve the skin quality
and address the dark circles.
Now that being said, let’s say after all this is done and you’re still bothered by
the tear trough.
What we’ll typically do is we’ll combine Restylane or hyaluronic acid filler with platelet-rich
plasma and we can control and very specifically mold the area of the tear trough and get a
very nice result.
Now it does require a maintenance but from experience and from my style, I like predictability
and when there’s a potential risk of an undesirable appearance, it outweighs the benefits,
it’s not worth doing.
So, I like using fat in grafting in other areas.
I’ll place it in hands for hand rejuvenation.
I’ll place it in the nasolabial folds but I don’t place it under the delicate eyelid
skin where it can be very obvious or disappear altogether.
A lot of times, people who have fat placed under the eyes will have problems with chronic
swelling.
So that’s my advice, that’s my opinion.
It doesn’t mean in any way that your surgeon is wrong and probably discussing the merits
of fat under the eyes and the timing of when to do is worth discussing with your surgeon.
So with that being said, I hope that was helpful, I wish you the best of luck and thank you
for your question!