Scottsdale – Fat grafting is a popular procedure for rejuvenation of the face and contour improvement in the face and body. I have used fat grafting for the past 8 years to compliment my facelift technique and for body contour improvement. I recommend fat grafting for many conditions except in breast augmentation and eyelid rejuvenation.

A recent article in Aesthetic Plastic Surgery reviews the potential complications which can result from fat grafting to the lower eyelids. The study presents a single case where a patient received fat grafting to the lower eyelids 5 years before consulting with the senior author of the article. The patient had the initial procedure in Germany and experienced a deformity of the eyelids at the time. According to the patient, she had a second fat graft procedure in an attempt to correct the deformity created by the first procedure. The result was worse and as time passed the patient became increasingly dissatisfied with the appearance of her eyelids.

The patient presented for correction and a surgical lower blepharoplasty approach was used. The fat graft was viable after 5 years and was located in a non-anatomical location between the skin and the orbicular muscle. Interestingly, there was no need to remove any orbicular fat. All the fat graft was successfully removed. The total volume of fat graft removed was 1.2 cc from the right and 1.8 cc from the left eyelid.

This case illustrates a couple of important facts about fat grafting. First, fat grafting like all other plastic surgery procedures can be associated with complications and may even require re-operation to obtain a better outcome. Second, fat grafts are more likely to be problematic when the fat is placed superficially where it is more likely to create contour deformity as shown in this case. In the eyelid, because it is so anatomically thin, the margin for error is very low, as there is a good chance some of the fat graft could end up in a shallow location. There are very good surgeons who can avoid this complication, but I have seen this exact complication in many patients even in the hands of experienced clinicians. For eyelids, I believe that standard blepharoplasty techniques are more predictable than fat grafting.

I am a proponent of fat grafting when I can place it deeply. Fat grafting can be performed safely and can be successful in achieving aesthetic goals. When I perform fat grafting to the face, for instance, I use a low pressure injection technique with very small volume placed per injection. The article points out that inappropriate injection technique has likely contributed to the very serious complications of fat grafting previously reported by other authors.