Is Fat the Secret to Youthful Eyes?

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It's a nearly inevitable part of getting older: dark circles, under-eye bags and hollows that seem to become more and more pronounced as the years pile up. To revive the under-eye zone, many physicians rely on a lower blepharoplasty or injectable dermal filler, but fat transfers, another tool in the rejuvenation toolbox, can also help give the area a youthful plumpness. 

So when is fat transfer the right choice, and what are the considerations before booking an appointment? We turned to the pros for the scoop.

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What Exactly Is Under-Eye Fat Transfer?
While that's the term that's commonly used for the procedure, as Beverly Hills, CA oculoplastic surgeon Raymond Douglas, MD explains, the treatment involving transferring fat from one part of the body to another goes by many names. “Under-eye fat transfer can also be referred to as fat grafting, micro-lipoinjection or autologous fat transfer. 

The procedure involves removing excess, unwanted healthy fat from other parts of the body and placing it around the orbital areas, in this case, the tear trough, by injection, to fill where a hollowed area is causing visible signs of aging.”

Who It’s For
According to Laguna Woods, CA facial plastic surgeon Cory Yeh, MD, “a good candidate for under-eye fat transfer is a patient who feels that the hollowness to their lower eyelid area makes them look tired. They would typically demonstrate significant volume loss to the lower eyelid and upper mid-face area. Many patients who have previously used filler in this area may want to try fat transfer as an alternative technique in order to achieve longer-lasting results and a natural and smooth transition from the cheek to the lower eyelid.”

Who It’s Not For
While fat transfers can be a good option for some, Dr. Yeh says there are some patients who should avoid it: “This includes patients who smoke or who have an intense exercise regimen. These two factors may significantly limit how long the fat is able to last.  Also, patients who demonstrate a negative lower eyelid vector, such as patients with prominent eyes and a deficient upper cheek. These may see very little improvement with a fat transfer technique.”

How Long It Lasts
For patients who want to scale back on having to maintain filler treatments with visits to the doctor several times a year, fat transfer is a longer-lasting solution. “We cannot say that fat transfer is absolutely permanent, as we are always aging and losing fat as we age,” explains Dr. Douglas, “but it is almost permanent as opposed to using a synthetic filler which has a volumizing life of on average 18 months to three years. 

Natural fat transfer into the tissue does require an advanced level of technique and understanding of which fat to use, how much to inject, the percentage that will ‘live’ and how it is placed in the region of the upper cheek and lower eyelid to achieve the desired outcome after the inflammation subsides.”

Is It Time to Ditch Filler?
While fat transfers have gained in popularity, for some physicians, like New York oculoplastic surgeon Irene Gladstein, MD, it's not their go-to under-eye treatments. “I personally am not a fan of fat transfer in tear troughs and so I don’t offer it to my patients,” she says. “To correct orbital hollow, I use contouring approach that combines collagen stimulants and fillers.I use hyaluronic acid filler applied in a very controlled, gradual fashion to be a ‘cherry’ on the eyelid cake and complete the transformation in the area.”

Dr. Douglas, who does perform fat transfers, believes fat transfers are a good choice for patients who want to avoid risks associated with dermal fillers: “There are some advantages in using filler in that it can be very precisely placed in small areas,” he says, “and, if there were issues with overfilling, a negative reaction or an unnatural effect, it can be easily reversed. Most fillers are composed of hyaluronic acid, a naturally occurring substance in bone, cartilage, and skin that is bio-engineered so, it is very rare for rejection. However, there can be severe side effects such as injecting filler into a large blood vessel.”