Fat injections under the eye

A photo of a patient's face, zoomed in on her right eye, showing bags under the eye.

What can one do for bags under the eyes? There are three different approaches to correcting lower bags under the eyes:

  1. Lower blepharoplasty
  2. Injectable fillers
  3. Fat Injections

I now consider Fat Injections as the technique which solves the problem the best.

Removing lower eye bags with a lower blepharoplasty

For many years, patients would come to me asking to remove the bags under the eyelids, saying the bags made them look old and tired. I usually recommended a standard blepharoplasty or Eye lift. That involves making an incision right under the eyelashes, lifting skin and the muscle that is right under the skin. I would then remove the fat. It was the standard solution but it had several drawbacks.

For one, the area under the eyelids would sometimes appear hollow. Sometimes the line separating the “bag” from the cheek skin would become a deep trough, highlighting the emptiness under the eyeball. On certain patients, especially those with shallow cheekbones the lower eyelid could hang lower, showing the white under the iris (the colored part of the eye). In some cases, the lid would pull away from the eyeball, causing excessive tearing and dryness.

For that reason, I started doing what is called subconjunctival blepharoplasty, where the incision is made on the tissue inside the eyelid, leaving the skin and muscles intact. I would then do a peel or laser to take care of the wrinkles. This solved the problems related to the lower eyelid, but did not help the hollowness under the eye. I accepted this, because it was the best technique we had.

Using fillers for lower eye bags

As Restylane and other Facial fillers gained popularity, I started injecting fillers in the trough under the eyelid on young patients. It helped camouflage or disguise the bag under the eyelid, and I started using this approach more and more. But what really struck me was the “WOW” moment after the patients saw themselves in the mirror. It changed their whole look! If you read my post on where people focus on the face (saccadic eye movements), you understand why a little thing like a smooth contour under the eyelids has such a big impact. As the saying goes, “The eyes have it”.

Fat injections for lower eyelid bags

More recently, a patient who had had a Facelift and blepharoplasty several years ago by another surgeon came to me requesting a “revision” facelift.

For correction of lower eyelid bags, I now prefer fat injections

Dr. Rodriguez

Since traditional facelifts do not address the area under the eyelids, and the area under the eyelids appeared hollow,

I thought that pulling again on her skin would make her look worse, tight and drawn. When I proposed Fat injections under the eyelid, she was not interested. To show her how this could improve her look, I injected saline in the upper cheeks and under the eyelids. The purpose of this was to imitate what real fat injections could do.

Talk about a “WOW” moment! After seeing the results that the saline injections produced (temporary), she agreed to the fat injection surgery right away. She had a remarkable result for a procedure done under local anesthesia, at a fraction of the cost any of the other surgical alternatives. This was a “big bang for the buck”.

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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23 thoughts on “Fat injections under the eye”

  • Angel Harbin says:

    How is the fat harvested and prepared for injection. I would like my laugh lines filled. I don't want fillers. Do you inject or do you surgically have to cut to position the fat
    • Dr. Ricardo L Rodriguez says:

      Angel: We inject the fat. Here's a link to how we prepare the fat The issue of injecting laugh lines is more complex than just injecting the line as it sometimes needs building up of volume in other areas. Fillers by themselves just address the line and that is why they never seem to work as desired. I will have Kelly at kelly@cosmeticsurg.net contact you. Thanks!
  • iris Nelson says:

    I had a facelift and under eye fat removal in 2005. My under eye was overcorrected with the fat removal. I am considering fat craft. Do you have multiple photos of procedures you did?
    • Dr. Ricardo L Rodriguez says:

      Iris: I can put you in contact with Kelly at kelly@cosmeticsurg.net and she can help. Fat grafting is extremely technique dependent and process is the most important factor in fat graft longevity and good results. Read this post on my blog about how fat graft processing is done well.
  • Jeanette says:

    Are you using Bellafill? If so do you inject with a small cannula or a needle? I have read many pro and cons on bellafill and would like to hear your opinion. I have a loss of volume in the cheeks and hollowing under my eyes.
    • Dr. Ricardo L Rodriguez says:

      Jeanette: We use bellafill and can use a cannula or a needle. Frankly, I think there are better choices for artificial filler. I like Sculptra because of its even, diffuse result. The best is your own fat. Fat grafts, done properly, last a lifetime. In addition, they not only fill the volume, but improve the quality of your skin by rejuvenating it. Talk to Kelly at kelly@cosmeticsurg.net for more details
  • Lorraine says:

    Dr. Rodriguez, In 2012 as I began entering my mid fifties my dentist extracted all but six of my teeth (leaving nothing on the top). My skin was relatively tight then, and I had a good jawline and a minimal number of wrinkles. People thought I was much younger than my 50 plus years. However, only a little more than two years later I look like my great- grandmother. My face is wrinkling and sagging at an alarming rate. My skin is extremely saggy. My eyes are drooping and baggy as well. people now say they bet I am the oldest because I look incredibly holder than my oldest siblings. It's almost embarrassing. I read somewhere that extracting teeth can cause pre-mature aging especially extractions that extreme. I want to know if that is medically correct? And can fat injections correct the problem of skin sagging. Thank you in advance.
    • Dr. Ricardo L Rodriguez says:

      Lorraine: You are having loss of volume on your face for 2 reasons. First, it is normal for women in their fifties to start losing adipose tissue volume in their face. Indeed that is why they get wrinkles- the support layer of fat right under the skin gets thinned out so the skin above wrinkles. Secondly, the loss of teeth causes a secondary loss of bone substance on both the upper and lower jaws. I think you would benefit from two things- fat injections, and dental implants. Contact Kelly at kelly@cosmeticsurg.net and she will gladly help you if you want to get a consultation.
  • Meme says:

    Hi, i just had fat injections done to my face, and i told my dr to inject fst under my eye area, and he said he would, he did a great job with my face, he injected the fat into my face through the inside of my mouth, leaving no needle marks on mu face, like my other dr did, which way is better? And my first dr put me under general, so i do not know which way he did it or how he did it, but my first dr managed to place a graft of fat inside my lower eye hollows, and i told my new dr to do the same, and it felt like he was injecting fat under my eyes too, but after surgery, i see that i still have hollows, and it ia accentuated by my cheeks which are fuller, what does it sound like my first dr did? It was an actual graft that i could feel and even though my first dr damaged the graft by pushing on it after surgery, part of thegraft survived, and i want to know if there is a difference between fat injections , and fat grafting, and what method did myfirst dr use to create a band of fat under both my lower eyes, did he subsequently inject fat together, did he use pearl fat grafting , did he place an implant or what does it sound like he did? And what way do you inject fat under the eye area, through the inside of my mouth, or through the outer skin, please explain in detail. Thanks!
    • Dr. Ricardo L Rodriguez says:

      1. There is a small risk of infection, according to some experts, if you inject thru the mouth. I personally have not seen any studies on it, but for me it's not worth the risk. I inject thru a very tiny needle prick and when I see patients a few months later I can barely see the marks.
      2. Not having seen pictures of you before or after surgery, there is no way of telling what the surgeon did.
      3. If you want to know my approach to doing fat grafts, read the following posts on the techniques of fat grafting. This one is about centrifugation. The next one is about which part of the fat graft syringe is better. The third one is about the general technique. The final one is also about technique.
      4. If you want me to give you a specific answer based on your pictures, contact Kelly at kelly@cosmeticsurg.net to set up a virtual consult.
    • Dr. Ricardo L Rodriguez says:

      Curtis: I assume you are interested in fat injections for your wife? Please contact Kelly at kelly@cosmeticsurg.net If she doesn't answer promptly, email me directly at dr.rodriguez@me.com We'd love to hear from you!
    • Kelly Warner says:

      Curtis, Dr. Rodriguez would be happy to consult with your wife and of course you're welcome to come. Please call our office at 410-494-8100 Thank you, Kelly
  • Sophie Meyer says:

    Hi, I was wondering what the diffrences are between the fat injection and the saline, does the effect of saline injections only last a day? and will saline spread or could it become a bump? (since the eye area has very thin skin, it might look obvious). Thanks
  • Linda Diefenbach says:

    I'm a 54 year old female trying to come to a conclusion about whether or not to have dermal fillers placed in the tear trough below my eyelid when I happened across your discussion about fat injections in that area. You mentioned using fillers as an effective treatment, however, you said the magic words "...I started injecting fillers in the trough under the eyelid of YOUNG patients...". Aside from the tricky nature of filling this area, is your feeling at this point that the dermal fillers are not the best option for filling tear troughs in older patients? Is the elasticity/thinness of the skin below the eyes that is the issue or is it something else? Thank you, Linda Diefenbach
    • Dr. Ricardo L Rodriguez says:

      Dear Linda: Although I started injecting fat and/or fillers under the tear trough in young patients, the vast majority of patients who get this now are women who are getting facelifts, or are looking for a limited procedure, such as an injectable, that will make them look younger. The peak age group for these procedures is 45 to 65 years old. I no longer feel this is a tricky area to treat with fat grafts or injectables, and as a matter of fact I recommend it to many patients my age (54, like you!). The key thing to realize is that you are not treating the trough itself, but the loss of volume in the upper cheek that has made the tear trough empty out and descend. Thus I inject more volume at a deeper layer. The end result is more subtle, yet at the same time more youthful than just levelling the tear trough.
  • Donna Schae says:

    Hi, I recently had fat injections under my eye, after firstly having a eye lid lift on the same day. Unfortunately I bled more than the surgeon expected, and my one eye remains puffy after having this procedure on the 13th of February 2009. I have tried putting ice on the eye every day and massage it so that it can go down, but nothing seems to be working. The procedure was done by a qualified cosmetic surgeon in South Africa, and I am not living in Melbourne Australia. Do you think he put too much in my eye, and now I will need to loose the weight to allow it to go down to its normal size. Please can you give me advise with regards to this as I am getting married in 6 months and hope it will have gone down. My surgeon advised that it will take time,but will go down in a couple of months and that I should be patient. I look forward to your response. Many Thanks Donna - Melbourne Australia
    • Dr. Ricardo L Rodriguez says:

      Unfortunately, not knowing exactly what the surgeon did or how the postoperative course went makes these problems hard to analyze from across continents. My best advice to you is to go see a Plastic Surgeon where you live and get an opinion from him. He will be able to see you in person and see and feel the eyelid and cheek area. By the way, I would see one or two board certified Plastic surgeons, just to get an idea of what the range of possibilities is. Let us know how the consults went. By the way, I never make any decisions about revisions until 4 months after surgery, so in your case, we'd be talking about mid June at the earliest.
  • Dr. Ricardo L Rodriguez says:

    hello Susan, When properly harvested, processed, and injected the fat graft is permanent. I use very fine cannulae to remove the fat, centrifuge the fat to get the best fat cells, and do micro re-injections. However, the fat injection procedure is very technique dependent and not every surgeon uses proper technique. That is why this procedure gets a reputation for not working permanently and why some surgeons need to perform additional injections. When done correctly , the fat graft is permanent and should not have to be repeated!