| 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.
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.
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