Why Fat Grafting is Not Advised Under the Eyes to Treat Hollowness, and a Safer Treatment

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

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