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Fillers vs Fat Grafting for the Lower Eyelid

Why does Dr. Steinsapir prefer “off the shelf fillers rather than body fat to fill under the eye? I thought fat transfer lasted much longer than off shelf fillers. What does he recommend and why?

Fat transfer has become very popular. Doctors are even calling them “stem cell facelifts.” Technically, adults stem cells are in the grafted fat, so there is a tiny grain of truth to this. Mostly though, it is a lie. These stem cells have nothing to do with the results accomplished with a facial fat transfer.

Dr. Steinsapir finds that fat grafting to the lower eyelid is an inferior treatment. First it requires a surgical procedure to obtain the fat. Harvesting the fat requires a small surgery with definite, though rare, harvest site healing issues.

Placement of facial fat also requires a surgical procedure. It is common for the face to bruise with placement of the fat. The bruising commonly takes about 10 days to resolve. The take of the fat is not predictable. Experienced fat grafters including Dr. Steinsapir believe that about 60-70% of the grafted fat survives. Over filling the face with fat can make the face too full. Where that fat is placed in the cheeks, chin and temple areas the grafted fat tends to hide in existing facial fat. Dr. Steinsapir likes fat grafting when the face needs a good deal of volume.

However, fundamentally, the lower eyelid is not an ideal location for fat grafting. The reason for this is poor tissue coverage. The dark circle or tear trough is defined where the lower eyelid orbicularis oculi muscle inserts into the bone of the maxilla. This means no fat under the insertion of this muscle, the thinnest spot of the dark circle. Putting the fat above or in the muscle is a sure way of making bumps. You don’t want bumps, especially not bumps caused by grafted fat. Unlike certain fillers that are prone to bumps, those fat bumps are not going away. 20 years from now those fat lumps will still be there. In fact if you happen to gain weight since your fat grafting, guess what? Your lumps will gain volume too.

How common are lumps after fat grafting? Gee, fat grafters as a group don’t report this information. Many of these patients find their way to Dr. Steinsapir’s office for help. Some of them were made worse because a well meaning surgeon injected the bump with corticosteroids to melt them away. They show up with a lump where the grafted fat is and a hole where the steroids have damaged the natural lower eyelid fat. 5-florouracil is sometimes used to modify the unwanted lumps from fat grafting. This is an anti-cancer medication that can sometimes modify scar tissue. However, when this does not work, actual eyelid surgery is needed to remove these nodules of grafted fat. It is Dr. Steinsapir’s opinion that as many as 30%, possibly more of patients who have had fat grafting to the lower eyelids have unwanted lumps.

Now compare this to filling the dark circle with Restylane. Restylane is an office service and does not require surgery. No second wound is needed to obtain the material. The product is available with local anesthetic. Using a topical numbing cream applied to the skin also helps to make the procedure very comfortable. Deep anesthesia is not needed. Restylane can be shaped to the face once injected. You can reapply makeup two hours after treatment so down time is minimal. It is possible to bruise from this type of treatment but typically the bruise is not as profound as that associated with fat grafting. If there are any lumps, bumps, or unwanted highlights on the skin, these can easily be modified with an enzyme called hyaluronidase.

Restylane often lasts a year or more. This treatment is easily performed by an experienced midface injector like Dr. Steinsapir. It can be adjusted at any time in the office setting with a very safe injectable enzyme. This certainly beats needing to have surgery on the face or needing the face injected with an anticancer drug.

Fat grafting does it last? Yes, certainly. However, after fat grafting it is very common for swelling to persist for several months. It is all too common for individuals to become dissatisfied with the degree of facial improvement once the swelling has resolved many months later. Individuals who have been fat grafted, often feel that the volume from the fat grafting has disappeared. While this is seldom actually true, the deflation that occurs as the fat grafting heals causes natural disappointment with the procedure. This leads many to wonder if fat grafting was worthwhile. Combine this with lumps in the lower eyelid when fat is placed in the thin tear trough area and you have a formula for unhappiness. Given this reality, Dr. Steinsapir feels that under eye Restylane is almost always the preferred option over fat grafting the lower eyelid.

About Dr. Steinsapir

Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranks at the top with a handful of medical centers in the United States. Dr. Steinsapir performed his surgery on an outpatient basis at the Surgery Center at the UCLA Medical Center. Dr. Steinsapir addresses a broad array of cosmetic oculofacial concerns including cosmetic eyelid surgery, Asian eyelid surgery, endoscopic forehead lift, BOTOX and dark circle treatment. Contact us today to schedule a personal consultation with Dr. Steinsapir.

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