People suffering from hollowness under the eyes often consider fat grafting after doing
research online.
They like that fat is natural and can last longer than cosmetic fillers.
Fat grafting can help with volume correction areas where the skin is thick.
I have had good results with fat grafting for hand rejuvenation.
Unfortunately, it can be problematic in the thin skin under the eyes, which is the thinnest
in the body.
I’ve observed that many general plastic surgeons offer fat grafting under the eyes.
I will discuss the pros and cons of fat grafting under the eyes, in particular my experience
caring for patients who had complications such as irregularities from variable healing,
inflammation and scarring.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and
Reconstructive Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
As I said earlier, it is understandable why people want a natural material like fat to
be used to treat under eye hollowness.
They figure it is the lack of fat under the eyes that causes hollowness, so it is logical
to put fat back in that area.
They also may think that fat is a natural material from their own body, so their body
can accept fat more easily since it’s not a foreign material.
However, when you learn about the nature of fat, you will find that it does not behave
like you assume it will.
The term fat graft means that the fat is harvested from its original location such as the abdomen
with liposuction.
As a graft, it relies on the local tissue where it is transplanted to receive adequate
blood supply so it can survive.
Unlike a cosmetic filler, fat needs to have a blood supply in order to continue to be
viable.
If fat does not get adequate blood supply, it breaks down and can cause inflammation
and the creation of scar tissue.
In addition, I’ve seen situations where the fat or fatty tissue partially survived
and was placed at different levels of the under eye area resulting in highly irregular
contour.
Lumps and irregularities are the exact opposite of the goal of creating smooth volume in hollow
areas under the eyes.
I also often see people who had fat grafting elsewhere and complain that none of it stayed.
I say to them that they are actually fortunate since there is no need to do additional surgical
correction.
As a cosmetic eyelid surgery specialist, I am frequently contacted by patients to surgically
remove fat grafts under the eyes.
Removing grafted fat under the eyes is highly specialized procedure, and may take more than
one revision surgery.
There are times where I need to actually restore tissue quality under the eyes with regenerative
medicine technology such as the application of prp or platelet rich plasma and stem cell
based wound healing technology such as extracellular matrix before performing corrective surgery
due the degree of compromise in the delicate integrity of the lower eyelid anatomic support.
Fat grafting involves surgical recovery from where the fat was grafted, such as the abdomen,
as well as the graft site.
The abdominal recovery is usually not an issue.
Swelling from the placement of fat under the eyes can be significant for weeks to months
afterwards.
I’ve seen patients who had persistent swelling from damaged lymphatics years after having
fat graft surgery.
People also think that fat from their own body will not cause allergic reactions like
filler, or be more accepted by the body than filler.
Hyaluronic acid, which is used in popular fillers like Restylane and Juvederm, does
occur naturally in the body.
The chance of allergy is so low that we routinely place filler without having to do any skin
testing.
Hyaluronic acid fillers are safely metabolized by the body with time, and can also be easily
dissolved using the injectable enzyme hyaluronidase.
In my practice, for under eye hollowness that requires volume correction, I use hyaluronic
acid fillers like Restylane or Juvederm.
Softer or less thick fillers are ideal for the under eye area.
I place injectable fillers under the eyes using blunt cannulas instead of needles to
minimize the risk of bruising.
Blunt cannulas are less likely to pierce a blood vessel to cause bruising.
Unlike fat grafting, this is a non-surgical procedure and can be done in minutes.
Placement of injectable fillers in a way that is harmonious with the face is an art.
Knowledge and experience as an Oculofacial Plastic surgeon has been very useful for me
when I place hyaluronic acid fillers.
When it comes to lower eyelid aesthetics, I also look at the front of the cheek in an
area called the eyelid-cheek junction.
Sometimes, volume loss at the cheeks may leave filler placed under the eyes without proper
cheek support.
In such cases, I also add volume to the cheeks to support the under eye filler, and also
improve the global look of the whole face.
After placement of hyaluronic acid filler under the eyes, there is little downtime.
Most patients don’t experience any bruising, so they can return to their normal activities
afterward.
Some swelling can be present from the use of local anesthetic.
Swelling from injectable fillers is usually minimal, and if present, can resolve within
the first week.
If, for any reason a hyaluronic acid filler needs to be removed, it can be easily dissolved
with an enzyme called hyaluronidase.
Although most patients look good immediately after filler placement, I see my injectable
filler patients two weeks after the original procedure to see how the filler has settled,
and if any enhancement is needed.
Injectable fillers under the eyes can last up to a year before gradually being metabolized
by the body.
In my opinion, fat grafting under the eyes is too unpredictable with a higher risk for
undesirable outcomes.
Its for this reason, in my practice, I recommend the placement of hyaluronic acid filler which
has the advantages of convenience, safety and even reversibility.
I hope you found this information helpful...thank you for your question