Orbital Fat Grafting
for Upper Eyelid Hollowness

Sequential Healing to 18 Months After Surgery

Before

This patient presented with advanced hollowness (Doll's Eye Deformity) following blepharoplasty performed elsewhere several years earlier. Orbital fat grafting was performed on both upper eyelids through an incision made across the full length of the eyelid. Pearl fat was distributed into the anterior orbit as well as into the space just in front of the levator muscle. Strip fat was applied over the pearls because of the extreme depth of depression. View this patient's operation (Caution: Actual surgery photos) The pace of healing shown below is typical in a healthy patient. Once surgical swelling resolves, volume augmentation appears to be stable with no indication of loss over time.

Progress from Before Surgery to One Year After

Immediately after surgery

Four days after (Noticeable ptosis, or droopiness, is not uncommon in the early weeks and improves slowly over months.)

Two weeks after

Four weeks after

Six weeks after

Four months after

Eight months after

One year after (volume stable, mild ptosis persists)

Before

18 Months After (volume stable, ptosis resolved)   Grafting of structurally-intact fat seems to provide a durable effect analogous to that of a skin graft once it has established a new blood supply. Within days, the pearls adhere to one another and form a smooth layer in the precise deep anatomical space intended for normal orbital fat. Healed grafted fat has appeared entirely healthy when viewed during the few secondary operations we have undertaken in severe cases for additional augmentation. We have seen no evidence to suggest an ongoing gradual resorption similar to that often noted with injected fat in other parts of the face. In the patient shown here, there is little evidence of loss of grafted volume even after the first few days. Following resolution of swelling and bruising (which can vary from 4-12 weeks), the vast majority of results have been stable. A slight right ptosis (droopy eyelid) was present for the first six months, after which it improved gradually and then finally disappeared between 12-18 months. In the three patients in our series in whom the fat graft failed completely (two had already undergone mutiple revision operations elsewhere; one had never had surgery), volume loss was noted almost immediately. It thus appears that grafted fat either quickly establishes a blood supply and becomes viable or rapidly dies and is absorbed.

Eyelid Plastic Surgery
Los Angeles, Ventura, Santa Barbara, Southern California