Am I Good Candidate For Fat Injections Under My Eyes?

Q: Dr. Eppley, Hello! I was wondering if I would be a good candidate for fat injections under the eyes. I have attached pictures of my problem areas. 

Since I was a teenager I have always felt insecure about my dark circles. It doesn’t matter how much sleep I get, whether I exercise, or eat healthy. My dark circles never go away. 

I’ve heard of Juvederm and Restylane, but I was wondering if fat injections are better and if they last longer.

A: Your congenital dark circles are indicative of an infraorbital rim deficiency. As a result the puffiness you see is pseudo fat herniation. There are a wide variety of approaches to treating what you have, most of which involve adding volume. (synthetic fillers, fat injections, dermal fat grafts, alloderm grafts and various type of implants) There is also a technique of fat grafting known as fat transposition where the herniated fat is moved into the tear trough area.

The wide variety of treatment options speaks to the differing opinions about how to treat it. You can fundamentally break all of these procedures into two categories, non-surgical and surgical. Most people will try a non-surgical method first because it is non-surgical and it can be a test to determine if adding volume would be an effective approach. I would stay away from injection fat grafting as the first procedure because it is a surgery, irregularities are common and such irregularities are difficult to treat. Synthetic fillers are a safer initial volume approach because the use of hyaluron-based fillers are completely resorbable/reversible.

If one graduates to surgery orbital fat transposition or alloderm grafts are a more natural approach that always produce positive results although complete elimination of them is not assured.

Dr. Barry Eppley

Indianapolis, Indiana