Thank you for your question
You submitted several photos and you described in your question that you’re 4 months out
from having lower eyelid surgery and fat grafting.
And you’re questioning whether or not you’re still having some bruising or some swelling
in particularly with the tension being drawn to the left eye.
Well, with the photos you submitted and of course the absence of a physical exam, there’s
some degree of challenge of actually giving you as much accuracy as potentially possible
but I can share with you my analysis based on just the photos alone and your history.
To give you a little about my background, I’m a board certified cosmetic surgeon and
a fellowship trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan
and Long Island for over 20 years.
Cosmetic and complex reconstructive eyelid surgery is my specialty.
And certainly, issues related to similar procedures as what you have done, are things that I have
dealt with or cases which I have dealt with in my 20-year career.
So before going on with the specifics with what I think is happening, let’s start with
just what I see when I look at your photos.
You said that you had lower eyelid surgery.
Now it’s my belief that you most likely were attempting to improve puffy under eye
bags.
When I look at these photos, it appears to me that you still have puffy under eye bags.
And what I suspect was a strategy by your doctor was that instead of removing or reducing
the puffy under eye bags which are represented by something called lower eyelid fat prolapse
or herniated fat, the goal was to try to transition the cheek area by augmenting it or augmenting
at least from the bulge of the fat to the underneath in the eyelid to cheek junction
with fat grafting.
Fat grafting has been around for a long time.
And certainly, prior to the popular acceptance and introduction, I should say, of hyaluronic
acid fillers, we were always challenged with how to augment the face in areas where there
was volume loss.
You know, understanding that facial aging is not just descent or genetic accentuation
of issues such as fat prolapse but also volume loss.
So fat grafting has so much of the appeal because of its ideal natural source, the fat
that’s coming from your own body and when placed and healed, it stays for the duration
for the long term but the problem has always been the same: predictability and variability
of healing as well as prolonged swelling.
Without naming names, one of our most respected colleagues who has been advocating fat grafting
for many years has had unfortunately a lot of difficulty with people who he has treated,
the results because of the unpredictability.
And this is somebody who’s considered a real authority in this area.
And understandably, the problem is that the fat is not pure fat and nor is the ability
to take in the area that it’s placed consistent.
We always say that if we are going to consider fat grafting, I always tell my patients that
there is a 30-70% absorption rate of fat which means it can look too big and then not be
enough and two, it will most likely need a second procedure.
Now that’s my experience.
I won’t necessarily conflict with other colleagues but from perspective, you know
many of my colleagues do feel the same.
The situation that you’re dealing with probably is the natural healing process of fat grafting.
You know that when I look at your left eye, I notice that below the puffy bag, there’s
a little lump there and my suspicion there is that there is an area of fatty tissue.
Understand that fat grafting is not pure fat.
It’s taken out with liposuction and the material’s a mixture of fat cells and supportive
tissue as well as anesthetic fluid and regardless of how it’s spun and prepped.
When we use fat, I love using it for hands, I think it’s fantastic and in certain areas
of the face, it’s good but we will combine it with platelet-rich plasma.
We will use Acellular matrix to try to improve its viability, we get very good results but
I really discourage people from considering fat for treatment around the eyes.
So most likely, you are dealing with the natural healing process and fat grafting healing can
take a long time.
There are patients we have seen by referral who were either were scarred or had hard lumps
that had to be excised or they were swollen and they were just dealing with chronic swelling
that went on for years.
In our practice, when someone like yourself comes in, I usually recommend lower eyelid
blepharoplasty, typically a transconjunctival blepharoplasty.
We do it from the inside, we reduce the fat pockets, we’ll use laser and PRP to improve
skin quality and then to augment the cheek area to get some nice volume, we use the method
called the Y lift or we can use a cheek implant but we use the Y lift method to add volume
to cheek to create balance to the face.
In the modern world, people don’t have time and certainly the tolerance for the unpredictability
is basically zero.
Our patients after cosmetic eyelid surgery, upper and lower lids can come back a week
later and have virtually no bruising, be back to work and be doing what they normally do
and not wrestling with this chronic swelling issue.
So I think what you need to do is again maintain communication with your doctor.
Your doctor probably has a lot of experience doing this and will be able to guide you and
may need to put you on some anti-inflammatories or maybe need to inject some anti-inflammatory
as well but I would still would point out to you that there is a lot of puffiness under
your eyes so you may need some additional procedures to address that specifically.
So the take home message is that fat grafting can take extended periods of time to heal,
swelling can last a long time and that you may still need to address the puffy under
eye bags with a more definitive and less traumatic approach that can allow you to heal a lot
faster.
Again, it has been 4 months after surgery so there is still time to observe what’s
going on.
In the meantime, maintain communication with your doctor.
If you’re not comfortable, then find someone to get a second opinion with.
So I hope that was helpful, I wish you the best of luck and thank you for your question!