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  • Writer's pictureValluri Krishna

How to Correct Under Eye Bags with Fat Grafting & Blepharoplasty!

Updated: Aug 1, 2022

The Ageing Face!

Ageing of the human face is the result of both superficial wrinkling of the skin and changes in the internal 3-D structure of the underlying structures. The skin, soft tissues (subcutaneous fat, muscle, and fascia), and structural support (bone and teeth) are individually affected by the ageing process, but they also act in dynamic unison to determine the phenotypic presentation of the face throughout one's life. The major forces contributing to facial ageing include gravity, skeletal remodelling, subcutaneous fat redistribution and loss, hormonal imbalance, chronic sun exposure, and smoking. Other environmental factors that perhaps may affect facial appearance include mental stress, diet & work habits, drug abuse, comorbidities and disease.



The Under Eye Hollows or Carry Bags!

The causes of periorbital hollowness could be one of the many reasons for ageing changes as explained previously. The most common outcome of those changes is a hollowness under the lower eyelids due to volume loss. The delicate skin around the eyes can change because of lifestyle, diet, the amount and quality of sleep, and overall health. Some people are even genetically predisposed to having excess skin and dark circles under their eyes. Age and drastic changes in weight can stretch and weaken the muscles around the eyes to create hollows or bags of excess fat.


How does Fat Grafting help?

The lower eyelids are one of the most common sites for fat transfer. The lower lid/tear trough area often becomes dark and hollow with age. Placing a thin layer of fat carefully into this delicate area can make someone look younger and less tired. Fat grafting is a minimally-invasive method of rejuvenating the area under the eyes. A small amount of fat is harvested from the patient, typically around the flank or hips. The fat is then processed into nano fat and injected into the periorbital area under the eye. Placing a layer of fat below the skin can lighten the area significantly. The advantages of fat grafting can be summarized below:

  • Get rid of bags below your eyes.

  • Achieve a more youthful and energetic look.

  • Minimize dark circles under your eyes (less tired).

  • Reduce the effects of ageing like sagging skin and wrinkles.

  • Replenish sunken hollows under your eyes and cheeks.

  • Smooth creases or fine lines around your eyes.



When can one undergo Blepharoplasty Surgery?

Blepharoplasty, commonly known as eyelid surgery, provides a long-lasting solution to dark circles and sagging under the eyes. The procedure involves removing or repositioning excess skin, fat or sometimes even the muscles under the eyes. The redistribution of the fatty tissue keeps the eyes from appearing too hollow and sunken. This can be combined with a fat grafting procedure when needed for a smooth and more youthful appearance.


Can Dermal Fillers be used as Substitue for Surgery?

Injectable dermal fillers use synthetic or natural substances, such as hyaluronic acid, to restore lost volume and stimulate collagen production under the eye. A cosmetic surgeon strategically injects the filler under the eye to replenish the skin, which eliminates hollows and reduces the appearance of under-eye circles.


What’s the procedure of an under-eye Fat Transfer?

An under-eye fat grafting is an outpatient procedure that takes approximately half an hour to one hour. It is typically done as a daycare procedure when done as a standalone surgery, you can go home the same day, but someone else should usually accompany you.


For an under-eye fat transfer that requires a small amount of fat, the procedure usually begins when;

  1. The Anesthetist gives you IV sedation or puts you under general anaesthesia and

  2. The operating aesthetic surgeon administers tumescent anaesthesia to numb the sites from where liposuction is planned to carry out.

  3. A thin needle and syringe are used to harvest fat from your body.

  4. The fat is centrifuged to filter out impurities and processed into nano-fat.

  5. The skin on your face is sterilized and local anaesthetic is injected into the site of entry.

  6. He then uses a very thin needle to inject tiny amounts of nano-fat into the skin below your lower eyelids in a grid-like pattern. This is called fat grafting. You may feel a slight pinch or sting, but the actual fat transfer shouldn’t be painful.



What are the expected complications?

Because the skin under the eyes is so delicate with many tiny blood vessels, this area often bruises quite a bit, and one must be patient during recovery for bruising and discolouration to gradually fade. The common complications of liposuction or an under-eye fat transfer are:

  • Bleeding

  • Bruising

  • Infection

  • Lumps or cysts

  • Skin damage or scarring

  • Swelling (oedema)

In very rare instances, the filler may go into a blood vessel instead of underneath your skin. The filler can block blood flow and may irreversibly damage your vision.


Who is contraindicated from getting a fat transfer?

To get liposuction and an under-eye fat transfer, you need to have enough body fat for the procedure. People who are extremely thin, exercise intensely or are pregnant may have to choose dermal fillers instead. People who smoke may not be good candidates either. Smoking can affect how well your body heals from liposuction and responds to fat transfer.


What’s the difference between a Fat transfer and Dermal fillers?

Most dermal fillers are lab-made substances. These off-the-shelf dermal fillers are ready to use. They’re a nonsurgical cosmetic treatment. A fat transfer is a natural dermal filler that uses your body’s fat cells. Though it is a daycare procedure, sometimes fat grafting still requires full general anaesthesia and is more invasive than a dermal filler procedure. The results of a fat graft last longer than injectable dermal fillers, sometimes ranging between 10 to 5 years, while that of a dermal filler might typically last about one year. The cost of the procedure too plays a significant role in choosing among these options as, 1ml of a filler can cost around Rs. 45,000 to Rs. 15,000, for which a considerable amount of fat can be easily harvested costing almost the same.


Advantages of Fat Grafting over Dermal Fillers include:

  • Significant volume restoration.

  • Enduring results than dermal fillers.

  • Improved skin texture and tone.

  • Wrinkle reduction in certain areas, particularly around the eyes.

  • Using your own fat to fill the face instead of synthetic chemicals.

  • Fewer risks and side effects than facial fillers.

Advantages of Dermal Fillers include:

  • Significant wrinkle reduction and volume improvement.

  • No downtime, as opposed to the one or two days downtime from fat grafting

  • Immediate results in many cases are visible just after the procedure.

  • Less expensive than fat grafting, for fewer sites and less volume replacement required.


What other procedures can be combined with an under-eye fat grafting?

Depending on your aesthetic goals, your plastic surgeon may recommend cosmetic facial surgery as part of a combined periorbital rejuvenation. You may get these procedures in addition to, or instead of, an under-eye fat transfer or dermal filler. These more invasive surgical procedures require a longer recovery:

  • Brow lift.

  • Fat grafting for other areas of the face.

  • Facelift (rhytidectomy) or Thread lift.

  • Rhinoplasty (nose job).

  • Lower or Upper Eyelid surgery (blepharoplasty).

  • Chin implants or other types of facial implants.


Individuals who wish to undergo cosmetic treatment to correct dark circles or bags under their eyes should consult a board-certified plastic or aesthetic surgeon like Dr Krishna Valluri to discuss their options and for achieving the most acceptable results. Dermal fillers, fat grafts, and blepharoplasty are all safe, effective procedures that can be performed as a daycare procedure using a local anaesthetic. The most appropriate treatment depends on the patient’s goals, the type of issue to be corrected, and how long the patient would like the results to last. Dr Krishna Valluri is one of the Best Plastic Surgeons in Hyderabad, Highly Experienced in Facial Rejuvenation using Fat Grafting & Blepharoplasty techniques and has done many Successful Procedures.


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