While neither as physiologic nor powerful as orbital pearl fat grafting, placement of a dermal fat graft into the lower eyelid can be of value in milder cases of orbital hollowness. The graft can be inserted into the eyelid itself or used as a "spacer" along the back surface of the lid in cases of eyelid retraction accompanied by hollowness.
Employed as a one-piece implant rather than multiple pearl-sized particles, the graft consists of the skin's dermis with a thin layer of attached subcutaneous fat. When inserted fully into the eyelid, the dermis is thought to facilitate growth of blood vessels into the fat.
The graft can be obtained from any hairless area of skin. The most common donor sites include the flank, waist, and buttocks, as well as skin discarded from a simultaneous face lift. Dermal fat grafting has been used to add volume to the face and body for many years. The main complication is cyst formation beneath the skin.
The composite of dermis and fat is sutured either into or along the back surface of the lower eyelid rather than being placed deeper into the orbit. Generally, the attached fat is no thicker than 4 mm. Because the graft is placed more superficially in the thin and pliable lower eyelid, the risk of irregular contouring is increased as compared to use on other areas on the face.
