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Revision of Excess Added Volume
Possible But Difficult
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Even with careful volume augmentation of hollowed tissues by experienced eyelid surgeons, it is possible to overcorrect. The feasibility of at least partial removal of excess fat or a (semi)permanent filler is related to its method of initial introduction.
For example, while it is easy to inject fluid-like material through a needle or cannula into a readily inflatable multilayered tissue such as an eyelid (or the sponge shown above), pulling back on the plunger of the syringe once healing has progressed will not remove excess fat or filler.
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Even with microliposuction, removing semi-permanent synthetic fillers or fat cells that have been injected and then diffused into and between multiple delicate layers of the eyelid can be nearly impossible without damaging normal tissue and sometimes creating noticeable scars or surface irregularities and dents. Some overcorrections following injection are essentially untreatable by current methods.
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Excising excess pearl fat that has been grafted into its natural anatomical compartment behind the orbital septum is less destructive to the eyelid's tissues. Removal is similar to but more difficult than trimming fat through a skin-incision blepharoplasty.
Due to deep placement, some grafted fat cannot be removed without risking serious problems such as injury to an eye muscle or eyelid retraction. Because of the more solid texture of grafted fat as compared to natural orbital fat, even partial removal may cause uneveness or localized depression.
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Exploration at the site of previous lower eyelid pearl fat grafting eight months earlier reveals structurally-intact and healthy-appearing fat located behind the orbital septum.
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