Skip to content

Under Eye Fat Transfer: Possible Complications, and a Safer Alternative

People suffering from hollowness under the eyes often consider fat grafting after doing research online. They prefer fat because it is natural, and lasts longer than cosmetic fillers. Fat grafting can help with volume correction areas where the skin is thick, for example 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’ll talk about the benefits and drawbacks of under eye fat transfer, drawing on my experience caring for patients who had complications like irregularities from variable healing, inflammation, and scarring.

before and after tear trough filler treatment
female patient before and after tear trough fillers procedure by Amiya Prasad MD, NYC
It is understandable why people prefer to treat under eye hollowness with a natural material such as fat. They reason that hollowness is caused by a lack of fat under the eyes, so it makes sense to replenish that fat. They may also believe that fat is a natural material from their own body, so they reason that their body will accept fat more easily because it is not a foreign material. When you learn about the nature of fat, you will learn that it does not behave as you would think.

What is fat grafting?

The term fat graft means that the fat is harvested from its original location such as the abdomen with liposuction, and the graft material is dependent on the local tissue where it is transplanted for adequate blood supply to survive. In contrast to cosmetic fillers, fat requires a blood supply to remain viable. When fat does not receive adequate blood supply, it breaks down, causing inflammation and the formation of scar tissue.

before and after fat transfer to sub-brow to address hollowing
before and after fat transfer to sub-brow to address hollowing

Under Eye Fat Grafting Complications

I’ve seen cases where the fat or fatty tissue survived partially and was placed at various levels of the under eye area, resulting in a highly irregular contour. Lumps and irregularities work against the goal of creating smooth volume in hollow areas under the eyes. I also frequently see people who had fat grafting elsewhere and were disappointed that none of it stayed. I tell them that they are actually fortunate because no additional surgical correction is required.

lumps after under eye fat transfer
lumps after fat grafting illustration

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 a highly specialized procedure that may necessitate multiple revision surgeries. Due to the degree of compromise in the delicate integrity of the lower eyelid anatomic support, there are times when 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.

Fat graft excision before and after
Fat graft excision performed by Dr. Amiya Prasad before and after

Under Eye Fat transfer Recovery

Fat grafting involves surgical recovery from where the fat was grafted, such as the abdomen, as well as the graft site. Abdominal recovery is usually not a problem, but swelling caused by the placement of fat under the eyes can last for weeks, or even months. I’ve seen patients with chronic swelling caused by damaged lymphatics years after having fat graft surgery.

People also believe that fat from their own bodies will not cause allergic reactions like filler and will be more readily accepted by the body. Hyaluronic acid, which is found naturally in the body and is used in popular fillers such as Restylane and Juvederm, does occur naturally in the body. We routinely place filler without performing any skin testing because the risk of allergy is so low. The body safely metabolizes hyaluronic acid fillers over time, and they can also be easily dissolved using the injectable enzyme hyaluronidase.

Safer Alternative - Fillers for Under Eye Hollowness

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.

under eye filler injection before and after results
under eye filler injection before and after results

To reduce the risk of bruising, I inject fillers under the eyes with blunt cannulas rather than needles. 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 consider the area in front of the cheek known as the eyelid-cheek junction. When there is volume loss in the cheeks, filler placed under the eyes may not provide adequate cheek support. In these cases, I also add volume to the cheeks to support the under eye filler and to improve the overall appearance of the face.

under eye and cheek filler before and after
before and after under eye fillers
There is little downtime after hyaluronic acid filler placement under the eyes. Most patients have no bruising, and can resume their normal activities immediately. Swelling may occur as a result of the use of a local anesthetic. Injectable filler swelling is usually minimal, and if present resolves within the first week. If a hyaluronic acid filler must be removed for any reason, it can be easily dissolved with an enzyme called hyaluronidase.
under eye dermal fillers before and after
dermal fillers for under eyes before and after

Although most patients look great right after filler placement, I see my injectable filler patients two weeks later to see how the filler has settled, and if any enhancement is required. Fillers injected under the eyes can last up to a year before being metabolized by the body.

under eye trough filler before and after
under eye filler before and after pictures

Under Eye Fat Transfer vs Fillers

In my opinion, fat grafting under the eyes is too unpredictable with a higher risk for undesirable outcomes. It’s for this reason that in my practice, I recommend the placement of hyaluronic acid filler which has the advantages of convenience, safety, and even reversibility.

Appointment Request