Lower Eyelid Fat Injections

Q: Dr. Eppley, I am 28 years old and would like to discuss a lower blepharoplasty with fat repositioning. I should say that I have researched this quite a bit and understand the different options. I am only unsure of whether I need the transconjunctival lower blepharoplasty with fat repositioning into the tear trough at all versus whether I would perhaps only need lower eyelid fat injections without a blepharoplasty. I don’t want synthetic injectable fillers.I am attaching some photos for your review. I don’t have excess skin that would require the subciliary incision. Unfortunately, the photos don’t do justice to show that you can actually see several of my veins through my lower eyelid skin. The photos seem to always filter that out but in person, the circles are quite dark and the skin quite thin. I do not have pigmentation of the skin, however- it’s definitely due to the underlying structures. Thank you so much!

A: Thank you for your description and the comprehensive set of pictures sent. They all lead to the following:

1) Your young age and lack of any excessive skin eliminates any open lower blepharoplasty needed.

2) You do not have any herniated lower eyelid fat so fat transposition is not an option.

3) As you may have already concluded, fat injections would be the appropriate and only treatment option. (given that you have excluded synthetic fillers)

Fat injections to the lower eyelids is an exquisitely technique sensitive procedure in the very thin cover of lower eyelid skin. Over correction and lumpiness is not rare as the flow of concentrated fat is not linear due to its more irregular shaped globs of fat that are harvested and concentrated. I have learned to process the fat into an emulsified form to create a more even flow of the material as it is delivered through a microcannula for placement. I also like to add in PRP (platelet-rich plasma) with the fat to get the potential benefits of its growth factors on the cells. In a low volume injectate like that of the lower eyelids the ratio of fat:PRP would be quite favorable

Dr. Barry Eppley
Indianapolis, Indiana