Fat Grafting for Lower Eyelids

I consulted a surgeon in LA about this method and he stressed the difference between fat grafting and fat injections. He pushes using grafting (surgical) versus injections (non-surgical) saying that injections are not permanent and less likelihood of success post-op. Is this true? Also he takes fat from the lower abdomen, rolls them into pearl-sized balls and then places them behind the muscle of the lower eyelid to fill in the hollowness. He claims that he is the only person in the U.S. that does this type of surgery. Is that also true or are there other doctors who perform this type of fat grafting for the lower eyelids?


Hi tchick,

I also perform pearl fat grafting, but for upper eyelid hollowing. I do like this procedure.

Fat injections (AKA Fat transfer or microfat grafting) does work, and it can be permanent also. The early attempts at reinjecting liposuctioned fat failed (prior to the 1990′s), because a lot of the liposuctioned fat was destroyed and the fat was not purified. Fat injections these days in the surgeons who follow the correct technique, works more consistently (but it’s still not perfect.)

Fat transfer should not be used to directly inject liposuctioned fat into the lower eyelid fat. One risk of lower eyelid surgery is blindness. During lower eyelid surgery if there is bleeding of the fat, this can potentially lead to blindness if it is not recognized and the bleeding is severe. During a surgical lower eyelid procedure, the bleeding vessel can be found and sealed off with cautery. If a surgeon or dermatologist directly injects fat into the lower eyelid fat pocket and starts some bleeding this could be disastrous and lead to blindness.

Fat transfer is used for fat grafting of liposuctioned and purified fat between an circular eyelid muscle called the orbicularis oculi muscle above the fat grafts. And below the fat grafts is the bone of the eye socket and also the coating over the lower eyelid fat called the orbital septum. This is good for treating exposure of the rim of the eyesocket from atrophy (fat shrinking) of the upper cheek fat. So essentially the fat grafting is “restoring” this previously smooth transition.

The pearl fat grafting was originally designed for patients who previously had an over aggressive lower eyelid fat removal causing a collapse of the lower eyelid from a lack of fat supporting the lower eyelid. There are cases of patients who naturally have lower eyelid hollowing. I have been informed by other MMH members that two other eye plastic surgeons also offer pearl fat grafting, but probably don’t offer it as often as the surgeon you are referring to.

I don’t know your situation, so I don’t know if this is the right procedure for you. These two procedures do not give the same results and should not be considered interchangeable. I know that many of the fat transfer experts are injecting fat grafts to repair over-aggressive lower eyelid fat removal, but I have not seen any pictures showing improvement of the lower eyelid from fat transfer. The pearl fat grafting is a much more anatomically correct method of replacing the lower eyelid fat.

The lower eyelid fat pocket seems to be an ideal environment for solid pearls of fat, and there is a 70-90% survival rate which is good since overcorrection is not needed, as with fat injection. Fat injection have about a 50% survival rate at best, so this needs to be taken into consideration when counseling the patient. Either double the amount of fat is injected, and it takes several months for the extra fat to dissolve, or a conservative filling is performed, but more than one session is performed to “inch” towards the ideal result.


If the pearl fat grafts are “overdone” then the lower eyelid fat may bulge out like in someone with lower eyelid fat bags. This can be reduced with a traditional lower eyelid transconjunctival fat removal. With fat transfer (injections) if the fat is overinjected, it is very difficult to remove the fat since the fat is not in a specific area, and is scattered throughout a wide area.


Dr. Yang