thank you for your question you submitted several photos and you describedin your question that you’re 4 months out from having lower eyelid surgery and fat grafting.and you’re questioning whether or not you’re still having some bruising or some swellingin particularly with the tension being drawn to the left eye. well, with the photos you submitted and ofcourse the absence of a physical exam, there’s some degree of challenge of actually givingyou as much accuracy as potentially possible but i can share with you my analysis basedon just the photos alone and your history. to give you a little about my background,i’m a board certified cosmetic surgeon and
a fellowship trained oculofacial plastic andreconstructive surgeon, practicing in manhattan and long island for over 20 years. cosmeticand complex reconstructive eyelid surgery is my specialty. and certainly, issues relatedto similar procedures as what you have done, are things that i have dealt with or caseswhich i have dealt with in my 20-year career. so before going on with the specifics withwhat i think is happening, let’s start with just what i see when i look at your photos.you said that you had lower eyelid surgery. now it’s my belief that you most likelywere attempting to improve puffy under eye bags. when i look at these photos, it appearsto me that you still have puffy under eye bags. and what i suspect was a strategy byyour doctor was that instead of removing or
reducing the puffy under eye bags which arerepresented by something called lower eyelid fat prolapse or herniated fat, the goal wasto try to transition the cheek area by augmenting it or augmenting at least from the bulge ofthe fat to the underneath in the eyelid to cheek junction with fat grafting. fat grafting has been around for a long time.and certainly, prior to the popular acceptance and introduction, i should say, of hyaluronicacid fillers, we were always challenged with how to augment the face in areas where therewas volume loss. you know, understanding that facial aging is not just descent or geneticaccentuation of issues such as fat prolapse but also volume loss. so fat grafting hasso much of the appeal because of its ideal
natural source, the fat that’s coming fromyour own body and when placed and healed, it stays for the duration for the long termbut the problem has always been the same: predictability and variability of healingas well as prolonged swelling. without naming names, one of our most respectedcolleagues who has been advocating fat grafting for many years has had unfortunately a lotof difficulty with people who he has treated, the results because of the unpredictability.and this is somebody who’s considered a real authority in this area. and understandably,the problem is that the fat is not pure fat and nor is the ability to take in the areathat it’s placed consistent. we always say that if we are going to consider fat grafting,i always tell my patients that there is a
30-70% absorption rate of fat which meansit can look too big and then not be enough and two, it will most likely need a secondprocedure. now that’s my experience. i won’t necessarily conflict with other colleaguesbut from perspective, you know many of my colleagues do feel the same. the situation that you’re dealing with probablyis the natural healing process of fat grafting. you know that when i look at your left eye,i notice that below the puffy bag, there’s a little lump there and my suspicion thereis that there is an area of fatty tissue. understand that fat grafting is not pure fat.it’s taken out with liposuction and the material’s a mixture of fat cells and supportivetissue as well as anesthetic fluid and regardless
of how it’s spun and prepped. when we usefat, i love using it for hands, i think it’s fantastic and in certain areas of the face,it’s good but we will combine it with platelet-rich plasma. we will use acellular matrix to tryto improve its viability, we get very good results but i really discourage people fromconsidering fat for treatment around the eyes. so most likely, you are dealing with the naturalhealing process and fat grafting healing can take a long time. there are patients we haveseen by referral who were either were scarred or had hard lumps that had to be excised orthey were swollen and they were just dealing with chronic swelling that went on for years. in our practice, when someone like yourselfcomes in, i usually recommend lower eyelid
blepharoplasty, typically a transconjunctivalblepharoplasty. we do it from the inside, we reduce the fat pockets, we’ll use laserand prp to improve skin quality and then to augment the cheek area to get some nice volume,we use the method called the y lift or we can use a cheek implant but we use the y liftmethod to add volume to cheek to create balance to the face. in the modern world, people don’t have timeand certainly the tolerance for the unpredictability is basically zero. our patients after cosmeticeyelid surgery, upper and lower lids can come back a week later and have virtually no bruising,be back to work and be doing what they normally do and not wrestling with this chronic swellingissue.
so i think what you need to do is again maintaincommunication with your doctor. your doctor probably has a lot of experience doing thisand will be able to guide you and may need to put you on some anti-inflammatories ormaybe need to inject some anti-inflammatory as well but i would still would point outto you that there is a lot of puffiness under your eyes so you may need some additionalprocedures to address that specifically. so the take home message is that fat graftingcan take extended periods of time to heal, swelling can last a long time and that youmay still need to address the puffy under eye bags with a more definitive and less traumaticapproach that can allow you to heal a lot faster. again, it has been 4 months aftersurgery so there is still time to observe
what’s going on. in the meantime, maintaincommunication with your doctor. if you’re not comfortable, then find someone to geta second opinion with. so i hope that was helpful, i wish you thebest of luck and thank you for your question!
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