Thank you, Aztec Warriorz! This particular subject was important to me because many doctors still offer it, and many people ask for it, but the few eyelid specialists out there know the potential complications of grafting fat into the lower eyelids.
Amiya Prasad, M.D. I have to ask you something. I’m getting a chin implant because I have a very weak chin and weak jaw line. My dr told me the chin implant will not really help with the jawline but will definitely fix the weak chin. Do they not have chin implants that also will fix chin and jawline ? I just have been reading and many places say they do both.
Hi@@cameronjones1583, A chin implant will also help extend the jawline and improve the angle. There are pre-jowl, and jaw angle implants available, which can be done at the same time as a chin implant, depending on the issue. However, I do prefer to improve chin project and jawline angle and continuity with long lasting hyaluronic acid fillers at the bone level. Using thicker fillers are more convenient for the patient as they don't require surgery, they are more precise, and can be used as a trial before committing to implants. Fillers can be dissolved if you don't like the look, unlike implants that require surgical removal if they don't fit properly. You can refer to these videos about it: ruclips.net/video/dP5gLXQ9ECc/видео.html ruclips.net/video/q-TO2t6YHGA/видео.html
Hi Steven Carp, I actually made a video about the risks of under eye fillers, including what you've mentioned. Unlike complications from fat grafting under the eyes, complications from filler treatment can be prevented with the doctor's technique, and expertise. Here's the video, for your reference - ruclips.net/video/lA6ietCvZf8/видео.html
Hi@@simasher, Sorry to hear about your problem. I don't recommend, or perform fat grafting in the lower eyelids due to the high risk of complications, but I do remove grafted fat under the eyelids placed by other surgeons. Grafted fat requires surgical removal by an experienced surgeon. I hope this clarifies things for you.
I am so glad I saw this video, my surgeon was going to graft fat for my under eye hollows. I will now insist on fillers for my under eyes. Thank you so much Dr. Prasad!
Hi@@izemlinda5807, That isn't true since filler doesn't require a blood supply, and filler can hold its shape. You can look into the video for a more detailed explanation as to why fat grafting is generally an unpredictable procedure, especially under thin lower eyelid skin.
I had Juvederm injected under my eyes for hollowness. I had a horrible delayed reaction. It began after 2 weeks. I eyes became so swollen and the product became rock hard. I had to have it all removed which took 3 sessions. The scarring took 6 months to go away. The Cosmetic surgeon that Injected me is excellent and reputable. It was my personal experience.
Hi Schmitt Rasmussen, Sorry to hear about your problem. What particular brand of Juvederm was injected? While injectable under eye fillers are generally safe, there are still risks involved with them, which I featured in these more recent videos: ruclips.net/video/XY7RBviX0_o/видео.html ruclips.net/video/lA6ietCvZf8/видео.html
Hi Doc! I’m not sure if you’ve already talked about this on your other videos, but what’s your take on the recent findings that fillers don’t fully dissolve and just move around the eyes and might even cause blindness???
Hi RJ, The risk of blindness in filler treatment is not caused by the presence of hyaluronic acid filler, but the inadvertent injection into an artery. Hyaluronic acid filler can be dissolved, but in some rare cases it may be encapsulated. You can refer to this video about the risks of under filler treatment, and how they are minimized or avoided - ruclips.net/video/lA6ietCvZf8/видео.html
@@AmiyaPrasadMD hi Doc! Thanks a lot for taking the time to respond. Appreciate it a lot. I’m on the other side of the globe and it’s unlikely I can travel anytime soon to get mine done at your clinic. It can be confusing to get varied takes on fillers vs fat graft. Good to find addtl references like your videos. Thanks a lot for sharing your expertise! More power to you and your channel!
Hi Dr. Prasad, This video is so informative! Thank you. I have had two consultations with two different plastic surgeons regarding my under eye issues. I have both bags and deep hollows (lucky me). Both doctors have suggested the removal of the fat bags and then fat transfer to the hollows. Needless to say, the thought of fat transfer scares me death. I had hoped that I'd only need some sort of injectable. Would you consider it safe and effective to have the bags surgically removed, but then to fill the hollows with Restylane, etc.? I'm at a loss but really want to improve the very tired and old look I've been sporting. Thank you for your time.
Love how you are so thorough in explaining everything. :) What is your opinion on fillers causing autoimmune disease or flaring an already existing one? I realize that everyone says that hyaluronic acid occurs naturally in our bodies, which of course is true. However, fillers are made in a lab. A synthetic form of a naturally occurring substance. How can they still be called safe, and why are there so many articles on people having severe, long lasting immune responses? I have thought of getting them many times, but the possible side effects are terrifying. Thank you in advance for your thoughts. 😁
Hi Chantal Loyer, We have not seen any issues with autoimmune response to hyaluronic acid fillers. You may be referring to collagen fillers used in the past which required allergy testing before use. There are higher and more common risks related to food and water than with hyaluronic acid filler, so I hope that puts things in perspective for you.
Great video! I had Fat Grafting under my eyes in 2011. I’m so un-happy with my results now. I have swelling & lumps under my eyes now that I absolutely hate. I look like I have puffy black eyes 24/7. Seeing someone on the 28th to see what can be done to fix this. I can’t continue to live like this, I hate looking in the mirror.
So sorry to hear about your problem, Elaine Compton. I wish this video was out sooner to warn you about the procedure. I hope your surgical correction goes well.
Sorry to hear that,@@shraddhanikhil. Bumps from the inconsistent texture of grafted fat is one of the reasons why I don't recommend the procedure. If the issue persists, the only recourse is surgical removal of the grafted fat. I hope this helps you.
I had a consultation with a reputable and popular doctor and was told that I needed fat reposition with my lower lid blepharoplasty. I refused this, because I saw your video before my consultation. Am looking for a second opinion who doesn't offer this procedure, but seem most doctors do here in England. I think you would do well in England and on socal media with the great knowledge you have.
Hi Winter Blain, I'm glad the video helped you, and you can avoid the potential complications. My patients in the US, and those that come to the US from around the world are keeping me very busy, but thanks for your confidence in me!
Hi , Dr Amiya Prasad I wish I would of seen your video before I had fat injected under my eye . It was taken out of my other under eye . It caused a lump to form . An incision was made to drain the lump it has been just over a week since. The bruising and swelling has slightly gone down . The lump has slightly gone down . I was given chlorsig to use 1% for a couple of days, than to apply strataderm gel . How can I prevent this from happening again.
Hi @stantheman3713, Sorry to hear about your problem. Grafted fat under the eyes usually requires surgical removal. After removal, you may want to consider a treatment for hollowness with less chance of complications, such as a hyaluronic acid filler. You can refer to this video about treatment options for lower eyelid hollowing - ruclips.net/video/SF1O-tPVGO0/видео.html
Doctor Amiya, I just find this Video so happy to watch , Very helpful 👍, and Big Pardon I have a question I’m 62 it’s ok for my age to get fat grafting ??is’t high risk , and I ‘m still confuse, please let me know , can fat grafting has Side Cancer or damage face??, please let me know Thank you very much
Hi @nice9992, I don't recommend fat grafting under thin lower eyelid skin at any age because of the high risk of complications. Facial fat grafting such as in the mid face, or lower face also involves risk, as 30-70% of grafted fat does get reabsorbed soon after surgery, so more than one procedure is needed. If the appearance of facial fat grafting isn't what the patient wanted, then it is more difficult to reverse with surgical removal, rather than facial filler which can be dissolved non-surgically. At your age, I would have to perform a physical examination for what I recommend for you, but it would likely be a combination of a surgical lift, accompanied by volume enhancement. I hope this clarifies things for you.
Thanks for the information. I was considering fat transfer but wouldn't go for it after this seeing video.... loved your smile at the end of the video :)
Excellent! I had been considering under eye fat grafting, though will definitely now forego it in that location, just too risky! Where as, I'm not so concerned in other non eye regions.
Hi TR_NW, I'm glad the video helped you. You're that fat grafting in other areas is not as prone to complications as the skin is thicker, so it won't show the inconsistent texture of grafted fat. However, 30-70% of grafted fat is absorbed by the body soon after surgery, so you can expect more than one procedure to get the appearance you want. I hope this clarifies things for you.
Thank you, Patty Gavin! I'm glad the video helped you, especially in learning about a common surgery that is highly prone to complications. Thanks for watching!
Hi @e.L690, Hyaluronic acid fillers are actually the modern replacement of collagen fillers. Collagen fillers use bovine collagen, which requires allergy testing before treatment, and some patients still don't react so well to them. Hyaluronic acid fillers are hypoallergenic in comparison, as they are well-tolerated even without allergy testing. I hope this clarifies things for you.
Hi Ye80s, There are more predictable and safer ways to treat lower eyelid hollowness where the skin is extremely thin than fat grafting, such as hyaluronic acid fillers. Fat grafting can still be done when the skin in the area is thicker, such as the cheeks and lower mouth. I don't perform fat grafting under the eyes, but as an eyelid specialist, I do perform corrective surgery for people who had fat grafting done elsewhere. Most of the time, doctors who perform fat transfers under the eyes are not experienced with dealing the potential complications, which leads to revisions done by oculoplastic/ oculofacial surgeons like myself. I hope this clarifies things for you.
This video has been really helpful, thankyou doctor! Can you suggest of the next best alternative for under eye hollowness and wrinkles because I can't find a specialist doctor in my area. Also, I am not keen on using fillers due to its possible side effects. Well I am just 18, so this hollowness is seriously concerning me. Are retinol creams effective?
Hi Haya Han, Hyaluronic acid fillers are the safest way to treat under eye hollowness, and there no side effects from these types of filler if done properly. Hyaluronic acid naturally occurs in the body, so there is no risk of a foreign body reaction. As long as they are injected by an expert, there should be no issues. Retinol creams are good for moisturizing, but they are effective to add volume. If you can't find an eyelid specialist in your area, I suggest you wait until you find one, or consider travelling if you are unsure about the safety of doctors in your area. I hope this helps you.
Hi Awesomedia, You can refer to these videos about how I treat dark circles in my practice: ruclips.net/video/QBvjjvxPt2g/видео.html ruclips.net/video/S6_nTRr1tio/видео.html ruclips.net/video/jQUb67RpaAM/видео.html
Wow. I really respect you doctor, cos you are so honest!!! Is your definition of fat grafting the same as nano fat injections? Is under eye hollowness the same as having eye bags? I am quite concerned with doing blepharoplasty for my eye bags because currently I already suffer from dry eyes and also the possible long term side effects. I am contemplating nano fat pathway. Thanks.
Hi, Thank you for your kind words! Nanofat is still grafted fat, but with more refinement, which still behaves like fat in that it needs a blood supply to remain viable, and still has unpredictability in retaining its shape once placed in a new area. Under eye hollowness and eye bags can be related in same cases. Eyelid surgery can be done in people with dry eyes, as long as the surgeon has experience with dry eyes. Transconjunctival blepharoplasty which involves no external incision, and no lower eyelid skin removal is a safer, more predictable procedure than a Nanofat procedure. You can refer to these videos about under eye hollowness with eye bags, eyelid surgery for dry eyes, and transconjunctival blepharoplasty: ruclips.net/video/Q0QiNH7LUVI/видео.html ruclips.net/video/g0z5DmORXo4/видео.html ruclips.net/video/46Kp6ayfyzg/видео.html
@@AmiyaPrasadMD Wow dr, you are amazing! Thank you I shall watch those videos. I wish you were in Australia haha! Do you think fillers can work for eye bags instead of nano fat?
Hi@@wem-c9f, Fillers can be used instead of fat grafting, but fillers are only appropriate for mild cases of eye bags to camouflage them. Using fillers for larger bags can actually make them worse. You can refer to this video about how I choose between surgery or fillers for eye bags - ruclips.net/video/yszpZSOEGoQ/видео.html
Hello, Dr. Prasad! I have scheduled a consult with you for next month. Your extremely kind and professional patient coordinator, however, told me she is not sure whether you perform revision surgery to correct lower-eyelid fat-grafting complications. Since I would be driving down from Boston and the consult is not complimentary, I just thought I would ask you if you perform the procedure in general. I understand you will have to examine me in order to determine whether I am a good candidate, but do you perform such revision surgery at all? My complications are relatively mild compared with some horror stories one sees online and are limited to the lower eyelid (no upper-cheek or malar-area involvement). Thanks!
Hi G. G., I do perform revision surgery for complications due to fat grafting in the lower eyelids, (as you can see in the video, I do advocate strongly against fat grafting in the lower eyelids due to high risk of complications) but I do need to examine your case physically to determine if the benefit is worth the risk of surgery. No two fat grafting procedures are the same, so an examination of your case is crucial. I hope this clarifies things for you.
Thank you for this video. I had a fat transfer 6 years ago to fix hollow eyes and I have been wondering why nobody tells you what can go wrong. I have been searching for help. My transfer caused severe sagging and puffy almost like a bag under my bag. I look worse than before. I don't know what to do. I was also told I was overfilled and so I have done some Agnes RF to melt away some fat as well as RF skin tightening. Now I'm on my 3rd injection of PRF. Nothing has changed them. Do you think a skin pinch would help? I just heard that term. I am very cautious about making Decisions now. Any advice is appreciated. I warn everyone please do not do a fat transfer. Thank you for your time.
Hi Kristel LeBlanc, Sorry to hear about your problem. I've been warning people of the high risk of complications of fat transfers under eyes for many years. I would need to perform a physical examination before making specific recommendations for you, but often what is required is surgical removal of grafted fat. A skin pinch is not often done as it involves surgical removal of lower eyelid skin, which can possibly cause a skin shortage which can make complications worse, so I only do it in rare cases. An examination is needed for a proper second opinion. I hope this helps you.
Hi Dr Prasad. Thank you for this video. I've been looking to get my under eye wrinkles improved with erbium resurfacing, and I heard about fat transfer under the eyes. I just happened to come across your video so I am now certain that a fat transfer is not an option. I wonder if you know of any experienced surgeons in London who you may recommend for erbium laser resurfacing? I understand if you dont wish to recommend anyone, but I thought it's worth asking anyway. Thank you again for your videos. They truly are an enormous help to us all 😊
Hi NIKKI COHEN, I'm glad you saw the video first, as you can see in the comments some people find the video after they've had the procedure done, and are now dealing with the complications. I don't know a particular doctor in London who specializes in thermal treatments. I do advise you see a doctor who has several devices, as it shows experience, and they are not forcing one particular device on patients, but can rather select the ideal device for your specific issue, and your skin type. Also ask them what they do to prevent overheating, and overexposure. As for the videos, you're welcome, and thank you for watching!
I had seen another video warning that synthetic tear fillers can drift from where they were originally placed. Personally, I'd love to have some of my buccal fat injected under my eyes and into my smile lines to give my face the symmetry I had a few years ago
Hi Zikomo7, There are different filler materials, but I prefer hyaluronic acid fillers for safety, predictability, and reversibility. If hyaluronic acid filler migrates, which shouldn't happen if placed by an expert, it does not migrate far from the original location. I don't recommend fat grafting under the eyes, as the video explains. You can refer to these videos about the risks of under eye fillers, and why placement technique is so important: ruclips.net/video/lA6ietCvZf8/видео.html ruclips.net/video/fwTBCiGGQs4/видео.html
Hi anastasia46, It depends on the type of filler material. Hyaluronic acid fillers are metabolized by the body, and hyaluronic acid is naturally present in the body. Permanent and semi-permanent fillers are not metabolized, and I don't recommend their use, nor do I use them in my practice. You can refer to these videos about dissolving hyaluronic acid fillers, and why I don't perform or advise permanent and semi-permanent fillers: ruclips.net/video/a3YicyDoTZU/видео.html ruclips.net/video/CZJ05rjav3s/видео.html
Thank you so much for this valuable information. Also, I want to know where is your office so come and see you about our Eyes problem please let me know thank you so much I saw more video about the problem but really this video was something else once again thank you so much for the information
Hi @bobjhan3197, You're welcome. I'm glad you found the video informative and helpful. Our offices are located in Manhattan, New York City which you can call at (212) 265-8877; Garden City, Long Island at (516) 742-4636; or Vienna, Virginia at (703) 356-1336. You can also reach us through www.prasadcosmeticsurgery.com, www.puffyeyes.com, or www.eyelifts.com by filling out a contact form, and we will get back to you. I hope to hear from you soon.
Dear Doctor. I'd like to ask you what long term treatments you think will be used in the next 10 years that may be equal in safety terms to what is advised in the video. Thanks Valerio
Hi Valerio, Hyaluronic acid fillers done by a doctor experienced in the eye area are the safest for treating hollowness. As hyaluronic acid is naturally present and safely metabolized by the body, it cannot last any longer than it does currently. The problem with permanent and semi-permanent fillers is that they are resistant to human metabolism, and stay in the body too long as a foreign material. Silicone tear trough implants are a long-term option, but they need to be changed eventually, and many patients don't find the fit and material comfortable. I hope this clarifies things for you.
Sir Is the under eye holeness effect achieved by Adipeu cream permanent or will the eyes become dull again. I'm in my 20 so I think im too young for these kind of procedures can you suggest me something I have a little bit hollowness only visible when i smile can it be cured if i gain weight
Hi @anaya1817, I hope you understand that I can't speak for the cream you mention as it's not something I recommend, or know if it truly works. I usually treat hollowness under the eyes starting in the early 20s when the face has stopped growing. Orbital fat, which is the fat behind the upper and lower eyelids, is for cushioning and protection of the eyeball, so it's affected by weight loss, or weight gain. I hope this clarifies things for you.
Hi @hellishgirl6059, SVF is still grafted fat, so it is still unpredictable in texture and shape when the fat has to take to a new blood supply. Hyaluronic acid filler is a more predictable treatment because it doesn't need a blood supply to remain viable, and its custom shape can be retained. I hope this clarifies things for you.
This is killing me slowly 😣 I got fat injection under the eye a month ago to treat my hollow eyes... Now I have visible fat which makes me look like I'm 10years older. The surgeon told me he will inject a fat dissolving agent on it but he fears that he might creat a hollow/depression on my face🤦♀️. Please advise me what's the best thing to do. I have not left my apartment ever since because of the way I look. This is really killing me. I regret BIG TIME. This is the biggest most horrible lesson of my life😣😣.
Hi Viktoria Vicky, Sorry to hear about your problem. I would need to examine your lower eyelids to determine what the best treatment is for you. I made this video to help people avoid fat transfers in the lower eyelids because of its high rate of complications. Fat grafting in this area may require surgical removal or revision, but this can be determined in an examination. I hope this helps you.
Hi jja91785, The results of filler, or its migration, are determined by the skill of the doctor applying them, so a doctor good at filler application can avoid migration. I actually made some videos about these concerns, for your reference: ruclips.net/video/Brb4uTzzG88/видео.html ruclips.net/video/kpkIuOXkloI/видео.html ruclips.net/video/CWhtFHVifgk/видео.html
Great and informative video. May I ask how fat grafting under the eyes compares to fat mixed with stem cells injected in the same region? Is the mixture a safer option? It seem to look the most natural (not just in theory) than all the other options. Thank you for your time.
Hi Sue S., Fat grafting and fat grafting with stem cells are both pretty much the same thing. Yes, fat is natural, but fat naturally needs a blood supply to remain viable, and fat naturally has a lumpy and inconsistent texture, which can be seen through thin eyelid skin. Hyaluronic acid fillers are more predictable for texture, consistency, and end results, and don't require a blood supply. Hyaluronic acid also occurs naturally in the body, so they are hypoallergenic. These fillers can also be applied in minutes without surgery. I hope this clarifies things for you.
Thank you Dr. Prasad, It does clarify things, thank you! Where do you think it's safe to inject fat on the face? I was told that the stem cells need something to bind to in order to work and that on their own it's a bit pointless. As a person with a naturally thin face from day one added to a lot of volume loss due to ageing and endurance sports, I tried filler and I looked puffy and not at all like myself. I had it removed. It made a lot of sense to me what you mentioned about putting filler where bone loss occurs, can one do that with fat?
Hi Sue S., Facial fat transfers are safer where the skin is thick, such as in the mid face like the cheeks, nasolabial, and mesolabial folds. However, facial fat transfers are still not predictable as 30-70% of fat is absorbed soon after the procedure. Facial fillers are more predictable because they are metabolized gradually, and can be shaped, unlike fat. Fat cannot be placed at the bone level, but fillers can, but not many doctors place filler at the bone level. You can look for Y Lift-trained doctors to place it at the bone level. I am among the first Y Lift-trained doctors, and call my style Structural Volumizing as it restores volume at the structural bone level of the face. You can review how I place it, and the results in these videos: ruclips.net/video/CWhtFHVifgk/видео.html ruclips.net/video/Brb4uTzzG88/видео.html
Hi@@aldrinallanigue3671, Softer hyaluronic acid fillers, which are the safest to use, like Restylane-L or Juvederm XC last about a year. I hope this clarifies things for you.
Hi steven elton, What procedure are you asking about? I don't recommend fat grafting under thin lower eyelid skin because of the high risk of complications. While I do know colleagues in Nevada, we all have different aesthetic styles, and practice focuses. I suggest you look at before and after pictures of the doctors in your area, and consult a doctor whose results, and individual style resonate with you. I hope this helps you.
Thanks GOD for sending you doctor, one doctor recommended me do all fillers to fix tear through and also archive golden ration on my whole face while other doctor recommended remove eye bag, then fat grafting to whole face include tear through. I a, nervous about tear through area so I am happy to find your advise
Hi BiBi Beauty, I'm glad you had some healthy skepticism, as well as finding the video as fat grafting under the eyes is really not work the high risks involved in the procedure. I hope you did reach the part about treating the tear troughs more safely with cosmetic fillers, but in addition we do have this other video about treating under eye hollowness - ruclips.net/video/VzzsbNDlaHQ/видео.html
What would you recommend for eye brow filler? I have lost some volume in my eye brow (above upper eye lid) and would like to try and get this rectified. Many thanks
From the time you made this video, has fat transfer technology/technique, evolved enough to be safe around the eyes? Have the use of stem cells been explored to help with this procedure? To be honest, I would never do fillers because I’m looking for a more permanent result. I just want to replace the fat that my body lost around the eyes, but I want to do it safely. So, I’m wondering if any plastic surgeon has mastered how to do fat transfer around the eyes yet.
Hi @chariots8x230, The behavior of grafted fat hasn't changed - its texture and consistency are still unpredictable once fat is removed from its original blood supply, and has to take to a new blood supply. Almost all medical cosmetic procedures are not permanent because aging still continues if you have a procedure. You can refer to this video about - ruclips.net/video/TzQOCp5RRzU/видео.html
And polynucleotide biostimulators could be an alternative to hyaluronic acid filler in the malar sulcus? Or use the two in combination? Especially in a young patient. Thank you 😊
So you do recommend the fat grafting undereye in the upper part but not the lower part due to Complication and also how long would the fat grafting under eye last?
Hi zanyar 122334, The skin above the upper eyelid/lower brow is thicker than lower eyelid skin, so it doesn't show the inconsistencies in texture in grafted fat such as lumps that would show through the lower eyelid skin. While I don't perform fat grafting in the lower eyelids, as an eyelid specialist I do surgically remove grafted fat in the lower eyelids that was placed there by other doctors, so I still see this complication often. I hope this clarifies things for you.
Great video Dr. Prasad..!! If you don't mind, I have a quick question about fat grafting: When doing fat grafting on your face how high in the cheeks can it be applied away from the under eye area?
Hi varispujols, If fat grafting is chosen for the face, it should be limited to where the skin is thicker, so at most at the mid to upper cheeks. Keep in mind that filler can also be used in the cheeks, and since filler is metabolized gradually, and doesn't need a blood supply, the shape and results are more predictable. 30-70% of grafted fat is absorbed quickly by the body following a fat grafting procedure, and fat has inconsistent texture that affects shaping. I hope this clarifies things for you.
Would you suggest lasers/PRP procedure over fat grafting for under eye dark circles? Please let me know as I have contacted a few doctors and they only provide fat grafting services.
Hi @meenienegi4319, I don't recommend fat grafting at all for treating under eye dark circles, and you can see in the video the high risk of complications involved in fat grafting under thin lower eyelid skin. Even though I don't recommend or perform lower eyelid fat grafting, I see many patients who had this procedure come to me because their original surgeon can't remove the grafted fat when complications occur. Under eye dark circles can be caused by pigmentation, pooled blood, iron deposits, or thin eyelid skin revealing the darker anatomy behind the eyelid.While a physical examination is needed before making specific recommendations for you, these videos feature the ways I treat under eye dark circles in my practice: ruclips.net/video/QBvjjvxPt2g/видео.html ruclips.net/video/S6_nTRr1tio/видео.html ruclips.net/video/jQUb67RpaAM/видео.html ruclips.net/video/RHJodb437o4/видео.html
Thank you, Lilmisscostumedrama! We do have patients coming from around the world (under normal travel circumstances), so you can join our international patients, if you wish.
Hi Ionescu Ion, Softer/less viscous fillers are required for the under eyes as this area has a lot of movement with facial expressions, and Radiesse is a more viscous/ stiffer filler. Radiesse also has its own potential complications as the material calcium hydroxyapatite does not completely metabolize, so some of the material may always remain in the body, and even migrate. Hyaluronic acid is completely metabolized with time, and can be dissolved when needed. I hope this clarifies things for you.
Hi Bella Rose, Although I do know colleagues in the LA area, we do have different styles and specialties. I suggest you look at the results of prospective doctors, and stick wit one you trust. I hope this helps you.
Hi doctor The fat grafting in this video means stem cell fat transfer? I was thinking of this surgery to give the overall volume to the face and for skin rejuvenation. Do you recommend this procedure?
Hi H Owen, Stem cell procedures usually just mean fat transfer/fat grafting. While I have performed facial fat transfers in the past, but not under thin eyelid skin, there are other options and factors to consider when thinking about a "stem cell" procedure, which can be reviewed in this recent video - ruclips.net/video/eoiMTOU0A0A/видео.html
Thank you dr for your informative input. I have hollow under eyes and big space under my eyes that filler failed to fix. Can i do lower blepheroplasty to cut down excess skin and lift my mid face upward ? Cuase i tired mid face filler also didnt work either
Hi @alal85831, Removing lower eyelid skin results in a host of complications due to a skin shortage, from lower eyelid retraction, ectropion, entropion, rounding of the eyes, change of eye shape, etc.. A physical examination is needed to determine the best approach for your case. I hope this clarifies things for you.
I have hollowness/volume deficiency not directly underneath the yes, but in my midface/cheek area, forming what I believe is called a mid-cheek groove? I've seen two oculoplastic surgeons with good credentials who treat this area with fat transfer. Is this still "not adviced" or would that be a different situation? I just don't feel like they would do this regularly and revolve their practice around fat grafting to this area if it was that ill-adviced? I could consider fillers if I knew any injectors in my area, but there are none, so I can't fly out of country every few months to get fillers..
Hi Julian Nikolay Krogh-Fredriksen, The mid cheeks are different when it comes to fat transfer because the skin there is thicker. I have performed fat transfer in the mid-cheeks and lower mouth. However, you would have to consider that fat transfer is a surgical procedure, and you may need at least two procedures as 30-70% of transferred fat is absorbed by the body. I hope this clarifies things for you.
Hi Johanna Sanchez, I do perform tear trough implants, which I insert through the transconjunctival method, so there is no external incision. Tear trough implants are not permanent because facial volume and proportion changes with age, so the implants will need to be changed after some time. I do find filler to be more convenient for patients as it involves no surgery, and fillers are very flexible with facial expressions like smiling, so they look very natural. I hope this clarifies things for you.
Hi doctor, is it possible to minimize the risk of fat transfer if it's done by an experienced doctor and with a conservative amount of fat over multiple sessions? I have small hollows both above and under my eyes and getting fillers for both every year would probably be really economically taxing, so i really wish for a more permanent solution
Hi Andrea Marteddu, As an oculoplastic surgeon who revises fat transfers under thin lower eyelid skin performed by other doctors, I can't recommend it because it is too unpredictable, and too prone to complications. I have done it in the upper eyelids/lower brow where the skin is thicker, but it usually requires a repeat surgery due to 30-70% of fat not taking, or being absorbed soon after surgery. I hope this clarifies things for you.
Hi Pink Horizon, Fat grafting can still be performed where the skin is thicker, such as the nasolabial area and forehead, but this video is a warning for fat grafting in the lower eyelids, which is the thinnest skin of the body and can show the inconsistency of the fat's texture. I hope this clarifies things for you.
@@AmiyaPrasadMD Thank you. It does. I'm just a bit nervous since there is a chance of lumps developing (risks of surgery, right?) and it cannot be dissolved compared to fillers. So there is lots to think about.
Dear Mr Prasad do you recommend fat transfer to the face at all? I am deciding between fillers and fat grafting after years of running I have a very thin face. I feel that the fillers are too short term and would cost more in the long run compared with a fat transfer to face. Can you give your opinion? Thank you Georgina
Hi gina Veale, I do perform fat transfers to areas of the face where the skin is thicker, but I have been using longer lasting fillers more lately. Understand that fat can also be absorbed by the body so it's not permanent, and fat transfer is a surgical procedure, so it can be more costly than filler application in the long run. Cosmetic filler treatment is more predictable than fat transfer, and it can be done in minutes since there is no surgery involved. I hope this clarifies things for you.
Hello, is there anyway to get even a rough estimate of the cost of your tear trough procedure for hollows? Being in Manhattan I'm sure u can charge plenty. Pls reply Dr.
Hi Lora A, You can contact our office directly regarding price range. You can call Manhattan at (212) 265-8877, and Garden City, Long Island at (516) 742-4636. You can also reach us through www.prasadcosmeticsurgery.com, www.eyelifts.com, or www.pufffyeyes.com by filling out a contact form, and we will get back to you. I hope to hear from you soon.
I had an upper and lower blepharaplasty done about 6 months ago. There are lumps on my upper lids and the surgeon did a medial incision on my lower eyes. Not happy. I have a visible scar. I was told it would eventually not be noticeable in time as I continue to age and just blend in. I am 66. Any recommendations? The scar bothers me. I hope I am saying this right - my cheeks are wrinkly and at times I have slight malar bags. Would fillers help this problem. One more thing - if you have fillers routinely, will the skin stretch and be worse? Thanks
Hi Vanessa Wood, I would have to perform an examination before recommending specific procedures that would help you. However, I can answer that filler does not stretch the skin, and I did make a video about it, for your reference - ruclips.net/video/hx540qDFbrs/видео.html
Hi Farah's Mirage, The brand of filler doesn't determine results, but it's the doctor's expertise, technique, and experience that determine results. Think of filler as the material, or in the case of sculpting, it’s just the clay. The clay itself doesn’t determine the sculpture, it’s the sculptor, or the doctor that determines the final appearance. You can refer to this video about it - ruclips.net/video/fwTBCiGGQs4/видео.html
Hi GT, Doctors have different practice focuses, so it's hard to recommend one. I suggest you look for a doctor who is experienced in what you want treated, and look at their before and after pictures to find an aesthetic style that resonates with you. I hope this helps you.
Hi dr...I’m 35 years old and I don’t have bags or hollowness under my eyes, but I do have very noticeable wrinkles under my eyes, especially when I smile, what is the best treatment for that?
Hi MinhChau Nguyen, I generally don't recommend treatment for skin bunching under the eyes when smiling, and best treatments can only be determined after a physical examination which also assess your skin type, but you can refer to this video on how I generally treat wrinkles around the eyes - ruclips.net/video/PXMhY90TReM/видео.html
I have had fillers put under my eyes, twice. Both times my body metabolized it (?) within a few weeks. Then I got fat grafts, and now, four months later, those too are gone. Very frustrating!
Hi Katharine Lang, Sorry to hear about your problem. I've actually had many patients complain about the same thing when having filler applied by other doctors, and with a change in placement technique, and perhaps type of filler, we can achieve longevity of filler of about a year. I hope this helps you.
Would you say to avoid fat transfer in the cheeks, next to the nasal bridge? I am looking at both submalar implants and fat transfer to create anterial volume due to my unnatural cheek placement
Hi Laura Thomas, I only advise against fat transfer under thin lower eyelid skin, but I have performed fat transfer in the cheek area. For fat transfer, you do need to factor that 30-70% of transferred fat will be absorbed, so prepare for at least two surgeries. I would also recommend you consider filler for cheek volume, which can be done without surgery in minutes and last up two years. You can watch this recent video about it: ruclips.net/video/GlF2ePf1AGw/видео.html
Hi @manurasamarasekara2821, The risks for fat grafting in the lower eyelids, and filler in the lower eyelids are not the same as the shape, and texture of filler are far more predictable than grafted fat. Risks of under eye filler have more to do with technique in which it's applied rather than the predictability of the material. You can refer to this video about the risk of under eye fillers - ruclips.net/video/lA6ietCvZf8/видео.html
Hi Jen Davis, Nanofat is still grafted fat, and once fat is removed from its original blood supply, it does behave unpredictably in terms of its consistency of shape, and taking to a new blood supply, so the potential complications are still the same as is shown in the video. I hope this clarifies things for you.
I'm glad you found the video helpful, Johan Heyns. You can refer to these videos about the safer, more predictable options to treat under eye hollowing: ruclips.net/video/VzzsbNDlaHQ/видео.html ruclips.net/video/Q0QiNH7LUVI/видео.html ruclips.net/video/46Kp6ayfyzg/видео.html ruclips.net/video/m-_mFe4eWmo/видео.html
Doctor, filler results last like a few months and they migrate easily, isn’t fat grafting better if you don’t have much fat around the eye? Especially if done by a very experienced doctor with decades of experience, and does lump only appear when they put too much in at once and not little cc at a time? I heard only 50% of the fat survives so they usually overfill? Is there many cases of good results or are you saying this because majority of the results are failures?
Hi @trentlaststand4574, As explained in the video, this is why I don't recommend fat grafting under the eyes: - the shape and texture of grafted fat can be irregular and lumpy once removed from its original blood supply - thin lower eyelid skin (0.5mm thick) can show the lumpy texture of grafted fat - as an eyelid specialist, I often surgically remove grafted fat under the eyes because the patient experienced the above. Doctors who place grafted fat under the eyes often can't remove it if complications occur. Hyaluornic acid filler under the eye is more predictable as it doesn't require a blood supply, the shape and texture are customizable, and if migration does occur, it doesn't migrate far from the original position. Hyaluronic acid filler can be dissolved if needed, while grafted fat requires complex surgery to be removed when complications occur. Incidence of complications are much higher with grafted fat in the lower eyelids than with hyaluronic acid filler. I hope this clarifies things for you.
@@AmiyaPrasadMD i went to consult plastic surgeon today and he does not recommend dissolving filler as it could potentially destroy the skin, I was gonna dissolve it to get fat grafting. Why does filler always migrate around the temple or near the tear trough but not the cheeks? This is the only reason why I considered fat grafting. I never had trouble with fillers near the cheeks it stays and doesn’t really migrate. My thin lower eyelid is actually very thin genetically i can see the blood vessel, is there a way to thicken skin here without grafting?
Hi@@trentlaststand4574, I don't think that dissolving filler affects the skin significantly, and made several videos about it for your reference: ruclips.net/video/P2a23JIrf6w/видео.html ruclips.net/video/-xepTFX83Lc/видео.html ruclips.net/video/a3YicyDoTZU/видео.html
How about fat graft on forehead nose bridge tip of the nose and chin area. When to see the final result? How long the fat will dissolve in these areas. Coz i dont want them anymore. The fat transfered on chin pull down my lips😢
Hi @richapandey7646, Hyaluronic acid fillers are meant to metabolized after about a year for safety, as semi-permanent, and permanent fillers are prone to foreign body reactions, and infections. Silicone tear trough implants are an option, but many people find them uncomfortable, as opposed to hyaluronic acid fillers feel more natural. I hope this clarifies things for you.
Hi Aman Keahri, I have done some videos specifically about dark circle treatment, and you can watch these latest ones: ruclips.net/video/S6_nTRr1tio/видео.html ruclips.net/video/QBvjjvxPt2g/видео.html ruclips.net/video/jQUb67RpaAM/видео.html
Hi @albintangring1110, PRF is great for improving skin quality, texture, and thickness. However, the volume effect of PRF only lasts about 3 weeks, so it's not a replacement or alternative to hyaluronic acid fillers. You can refer to this video about it - ruclips.net/video/5f7_CLtYzNY/видео.html
Hi Randoindabando, There are different materials used in cosmetic fillers. I am describing hyaluronic acid fillers, which are the safest to use because hyaluronic acid naturally exists in the body, so they are biocompatible, and are metabolized safely. Metabolization is a good thing because if they last too long, your body can have a foreign body reaction to the filler material, and treat it as an infection. Also, fillers that stay too long in the body can break apart and migrate into deeper tissue where they can't be fully removed if there are complications. You can refer to this video about why I don't administer, or recommend semi-permanent, and permanent fillers due to high risk of complications - ruclips.net/video/CZJ05rjav3s/видео.html
Hi Britney Lopez, The addition of PRP does not change the unpredictable behavior of grafted fat, as grafted fat still needs to take to a new blood supply, and cannot hold a consistent shape once removed from its original blood supply, so the uneven shape and texture can still be seen through thin lower eyelid skin. I hope this clarifies things for you.
Hello Dr. May I have your thoughts on CO2 laser on lower lids in conjunction with lower lid blepharoplasty? I see quite a few oculoplastic surgeons performing this. Does it leave unresolved redness or discoloration? Is it even needed? Thank you.
Hi Matt Smith, That is the same approach I would take. You can refer to these videos about treating eye bags, and under eye wrinkles separately: ruclips.net/video/46Kp6ayfyzg/видео.html ruclips.net/video/U7kJ4CMcJ0A/видео.html ruclips.net/video/PXMhY90TReM/видео.html
I suffered an orbital floor fracture 5 years ago. My orbit healed on it’s on. However, I have a sunken in look under that eye. What do you recommend? I’m looking for something more permanent that doesn’t migrate.
Hi H Hatesincels, Sorry to hear about your problem. I would have to examine your lower eye area before making a specific recommendation, but understand there are no "permanent" solutions as even tear trough implants won't fit eventually as facial dimensions change with age due to age-related volume loss. You can refer to this video about the different treatments for hollowing under the eyes - ruclips.net/video/VzzsbNDlaHQ/видео.html
Hi Mr Amiya Prasad. I wrote to you 1 month ago about my problem. 5 month ago I did lower blepharoplastic. But I don’t like it . Because now I have very big hallowness under my eyes. I have heard about polylactic injection for filling the under eyes. Is it good for my problem. Thank you very much for your response
Hi @OzodaSuyunova-bz1uz, Poly-L-lactic acid treatments rely on a biological reaction in the body to create volume, so they are not as predictable or precise as hyaluronic acid fillers featured in the video. I hope this clarifies things for you.
Hi how are you? Mr Amiya Prasad. Can i send you my picture? For getting advice from you. Because I live very far from you and our plastic surgeons in my country’s very inexperienced ? I am nervous now
Hi@@OzodaSuyunova-bz1uz, I hope you understand that I can't give treatment recommendations based on pictures alone as they don't reveal the anatomic details I need. Pictures help, but they can't replace a physical examination.
My sister developed what looks like a xanthelasma like appearance after fat transfer filler. Does this ever dissolve on it’s own? I feel bad for her, it looks awful .. are there any non-surgical solutions ? If not, can there’s be lasered out? Or treated like xanthelasma removal ? Thank you
Hi Debbie Eberhart, I would have to examine it first before recommending treatment. Since grafted fat does behave unpredictably once removed from its original blood supply, it can appear lumpy and irregular, which can be seen through thin eyelid skin since it's only 0.5mm thick. I would have to properly diagnose the issue before recommending specific treatments. I hope this clarifies things for you.
Hi.please answer me, i use derma roller under my eyes and now i have a lots of wrinkles just under my eyes. How can i treat them please. I think filler or botox it is no good just under i mean the erea directly under eyes. Please give me an advice
Hi @Nuumidia, Sorry to hear about your problem. Use of a dermaroller without proper training usually results in overly aggressive use, and not enough time between sessions for healing. While an examination is needed to determine the best treatment approach for you, you can refer to this video of the different treatment options for under eye wrinkles in my practice - ruclips.net/video/PXMhY90TReM/видео.html
Hello doctor...is there any filler which can last forever....you are saying that it lasts for 1 year only...then what is the fun of using it...even fat grafting lasts for a quite more time than fillers...then who is going to get injected year after year with the fillers
Hi Royal Boy, Permanent and semi-permanent fillers are highly problematic because the body reacts to them as a foreign substance, so infection, rejection, swelling, and migration are usual bodily reactions to them. The reason why other fillers are temporary is because your body metabolizes them safely, while permanent fillers resist metabolization. You can refer to this video more about it - ruclips.net/video/CZJ05rjav3s/видео.html
Hi@@mrcruel8910, Facial asymmetry is natural and normal, and everyone has it, including actors and models, so it doesn't need to be corrected if there is nothing wrong with it. It is usually unnoticeable by others. I only advise treatment for facial volume changes due to aging, or if there is a genetic volume deficiency. You can refer to this video about it - ruclips.net/video/DpTPMpi_t3s/видео.html
Hi Nga Nguyen, I understand why people may prefer fat as it's a natural material. However, once fat is removed from its original blood supply, it is an unpredictable material to work with. Fat grafting/transferring can be done in areas where the skin is thicker, like the cheeks, where it won't cause the same complications as in thin lower eyelid skin. However, fat is unpredictable in maintaining a shape, and 30-70% of transferred fat can be reabsorbed soon after the procedure. Transferred fat also requires a blood supply to remain viable, and if it doesn't take to a new blood supply, it will be absorbed. Hyaluronic acid fillers are more predictable in retaining a shape as they don't require a blood supply. Hyaluronic acid does naturally exist in the body, so these filler materials are safe to use, and are metabolized with time, but not as quickly as fat. Filler treatment also requires no surgery, unlike fat grafting that requires surgery to graft, and surgery to place it in a new area. I hope this clarifies things for you.
Hi Heena Desai, I hope you understand that I would have to physically examine your wrinkles, and determine your skin type before making specific treatment recommendations for you. I sent you videos on your other comment to show the different treatment options. I hope this helps you.
Hi Sissi Modanisa, Hyaluronic acid fillers attracting water is well known among doctors, so experience in placement, and knowing the right amount of material used are important. We follow up with filler patients two weeks after placement to see results after the filler material has settled, and enhance further if needed, and provide guidance about the behavior of hyaluronic acid filler when it comes to water. Hyaluronic acid fillers used in the eye area last about a year before being safely metabolized by the body. I hope this clarifies things for you.
I had a consultation with an oculoplastic surgeon who was unable to give me a lower lid blepharoplasty because I don't have enough fat to work with under my eyes and while he said I do have some slight puffiness I also have a tear trough deformity. He suggested at first getting fillers but then told me it's probably not the best option for me as I have thin skin under my eyes and they'd most likely show through and this is what he suggested after that, getting fat transfer but after watching this video I'm questioning whether it's too much of a risk that will likely not pay off? I'm really lost as what to do next. I'm 29 and it's no understatement when I say how awful I look, part of the problem I think is that naturally I'm a thin person and so is my face but I've had this all my life and I'm so confused what to do about it.
Hi Ashley, Sorry to hear about your problem. It doesn't make sense to me that a doctor would say fillers can be seen through thin eyelid skin, and recommend a fat transfer instead since grafted fat has more irregularities than filler, and would be even more visible through thin eyelid skin. I would still highly advise against a fat transfer under eyes. If you can't come see me for a physical evaluation and a second opinion, I suggest you do with another doctor experienced with filler under the eyes. I hope this helps you.
@@AmiyaPrasadMD Thank you for taking the time to respond and for making this video as it's given me useful information I can take with me going forward. I'm now seriously considering fillers as an alternative for now and possibly think of surgery when I'm older but fillers still make anxious due to the risk of blindness, I know it's rare but every time I get it done I feel that risk increases. Unfortunately unable to visit you at your clinic as I live all on the other side of the pond in the UK but may I ask one final question, I've read Restylane is the best option for tear trough fillers while Juvederm has some disadvantages which I read from a Dr Steve Weiner (thecinique.com), would you agree with that? Most clinics near me use Juvederm.
Hi@@ASHERZ7167, I use both Restylane and Juvederm for the under eye area, as it's technique that determines results more than the brand of filler. You can refer to this video about the risks and expectations of under eye filler treatment - ruclips.net/video/lA6ietCvZf8/видео.html
I hope you didn't find that out the hard way, Tezeta Nishan! Fat grafting under the eyes is still very commonly practiced, so I hope more people learn about its risks.
Im 29 yrs old, my hollowed upper and lower eyes caused me some stress and insecurities, i look totally different, what is the best permanent lasting natural treatment I don't like fillers Could stem Cell be a solution
Hi @SciDiscoveryNews, I hope you understand that expecting a permanent treatment is unrealistic, as we can't stop aging, and volume is lost throughout the face due to aging. Stem cell treatments are limited, and are not usually administered in cases to treat volume loss. Tear trough implants can be placed in the lower eyelids, but many report that they don't feel as comfortable or as natural as filler, and eventually they will need to be replaced as our faces can smaller due to aging. You can refer to these videos on how treat under eye hollowness in the lower, and upper eyelids: ruclips.net/video/SF1O-tPVGO0/видео.html ruclips.net/video/dCDRBngaq60/видео.html ruclips.net/video/Q0QiNH7LUVI/видео.html ruclips.net/video/C1pxoU7e1SE/видео.html
@@AmiyaPrasadMD hi doctor, thank you so much for taking from your time and answering, what I meant by permanent is that they will age Naturally with time and not disappear completely just because 2 years passed or something like fillers. I have struggling with hollowed eyes since age 25 due to staying up too late since then my face looks so different, the charm has gone in early age unfortunately
Hi@@SciDiscoveryNews, While there are thicker hyaluronic acid fillers that can last longer than a year, they are not meant for the under eye area because thicker fillers are meant for the cheeks, chin, and jawline that have little to no movement with facial expressions. Permanent and semi-permanent fillers are highly prone to complications like infection, and foreign body reactions from staying in the body too long without being safely metabolized. As I said previously, silicone tear trough implants are a possibility for longer lasting volume, but many people who end up having them find them uncomfortable. You can refer to this video about the high risk of complications from semi-permanent, and permanent fillers - ruclips.net/video/CZJ05rjav3s/видео.html
Hi Wendy Esther, Lower blepharoplasty is mostly performed for puffiness under the eyes. In some cases, puffiness can cause the adjacent area to look hollow in comparison, so blepharoplasty is the right treatment for relative hollowness in these cases. The safety of lower eyelid surgery depends on the expertise, and experience of the doctor, and technique is also important in the safety. Lower eyelid skin removal, and compromising lower eyelid support structures are the most common causes of complications. You can refer to this more recent video on how lower blepharoplasty can be done more safely - ruclips.net/video/URMaUf-hRsA/видео.html
Hi Michele Albanese, The skin above the eyes is thicker than lower eyelid skin, so the issues with lumpiness of grafted fat doesn't occur. I actually have performed fat grafting into the lower brow in the past, but the problem is more with 30-70% of fat being reabsorbed by the body soon after the surgical procedure, so it less predictable than a non-surgical filler treatment. You can refer to this video for more about it - ruclips.net/video/dCDRBngaq60/видео.html
hi doc , is it safe to have fat grafting on my right eye socket? i have bone fracture and my face became hollow especially my eye socket. I will have Lateral Canthopexy surgery bcoz of my scleral show , and also fat grafting for eye socket. i wanna know if it will look okay or natural in the long run? Thank you
Hi @Mixia02, As explained in the video, I don't recommend fat grafting behind the lower eyelids because of the high rate of complications due. Grafted fat can become lumpy, and has an unpredictable shape when removed from its original blood supply, and this can show through thin eyelid skin. I do recommend injectable hyaluronic acid fillers instead of fat grating. I hope this clarifies things for you.
Hi Daisy Fish, Nanofat may reduce complications like lumping since the fat is processed to be more fine, but it still needs to take to a blood supply before providing volume. Fat absorption by the body is still an issue with Nanofat, so the process is less predictable than filler, and may require subsequent treatments soon after the first. I hope this clarifies things for you.
@@AmiyaPrasadMD I had Restalyane Silk for under the eye hollows, and hated it once the swelling went down. I couldn't wait for it to dissolve it took over 2 years to dissolve but I still see it sometimes in the mornings. Never again.
Sorry to hear that, @@minkycat66. For results, placement technique is more important than the filler material itself. The filler is just the material, while it is the doctor's skill, experience, and artistic style that determines the appearance. The doctor's skill also determines how well the material is dissolved with hyaluronidase. I hope this helps you.
Hi By Isnata DIY, Nanofat is a process for filtering grafted fat, but it doesn't change the fact that grafted fat still needs to take to a blood supply to be viable, and the shape and texture of grafted fat can still be inconsistent and unpredictable once removed from its original blood supply. I hope this clarifies things for you.
I have a question dr. Prasad, If one gets fat grafting regardless of where it is, would it disappear if one looses weight and come back again if gained weight again? Or is there places this wouldn’t happen - if it happens at all?
Hi Sasannide, It's important to understand that with natural fat, you don't lose fat cells when you lose weight, but the fat cells do shrink in size and volume. Grafted fat behaves differently as 30-70% of grafted fat doesn't take to a blood supply, so those fat cells can be lost entirely soon after the procedure. Grafted fat cells that do take to a blood supply will also lose and gain size the same way native fat does. I hope this clarifies things for you.
Hi Naina, While the complications may not be as severe as fat grafting under thin eyelid skin, grafted fat is still unpredictable once removed from its original blood supply, so it doesn't hold a consistent shape, or provide a predictable amount of volume. I would still advise a hyaluronic acid filler instead that doesn't require a blood supply, and can maintain a predictable shape. I hope this clarifies things for you.
Hi realite miracle, The results from temporary swelling after the procedure, as well as the absorption of 30-70% of grafted fat quickly by the body should have been explained by your performing doctor. Quick absorption of grafted fat by the body is usually why 2 or more facial fat grafting sessions are needed for desired results. Gradual metabolization of hyaluronic acid fillers, more predictable results, less risk of complications, and no need for surgery are reasons why I lean towards facial filler treatment over facial fat transfer. I hope this helps you.
Hi Arian Business, The amount, and lighter viscosity of filler placed in the lower eyelid usually doesn't migrate. Filler migration is more likely using higher viscosity fillers in areas like the cheeks, as more filler material is used, and when placed at the fat or soft tissue level, they can't support the weight of the filler. I place cheek, and jawline filler at the foundational bone level, between the stronger muscle to hold it in place, and prevent migration. You can refer to this video about it - ruclips.net/video/Brb4uTzzG88/видео.html
I have a large dent in the middle of my forehead from an injury. Problem is, it’s in the Glabella area, the “danger zone” for fat grafting. What is my risk of blindness or problems in this area?
Hi Anders Franz, The glabella area can be treated with filler. Risks of blindness are reduced by the experience and expertise of the doctor working in this area. I've been able to inject to this area without complications. I hope this helps you.
Hi@@andersfranz5367, Fillers are more convenient for you in this area as it involves no surgery. There are very few permanent solutions that are safe and predictable. I don't advise permanent fillers due to high risk of complications, especially in this area. Hyaluronic acid fillers are safely metabolized with body with time. Grafted fat is also gradually absorbed by the body, but holding shape can be less predictable as fat does require a blood supply, and can be lumpy after removed from its original blood supply. I hope this clarifies things for you.
Hi @dammar117, Nanofat still behaves like fat - it needs a blood supply to survive, and once it is removed from its original blood supply, it needs to take to a new blood supply. When fat is removed from its original blood supply, its shape and texture change unpredictably, hence the lumpy texture. Hollowness and volume loss can appear in the lower eyelids if too much fat is removed during eye bag surgery. The art of lower eyelid surgery is to leave a little fat behind for a continuous contour from the lower eyelid to the cheek, and to prevent a hollow appearance. This is largely dependent on the experience of the surgeon performing the procedure. I hope this clarifies things for you.
@@AmiyaPrasadMD There's an article (I can't paste a link here, but the title is "Nanofat in Plastic Reconstructive, Regenerative, and Aesthetic Surgery: A Review of Advancements in Face-Focused Applications") that says that "The Lipogem technology [...] enables the isolation of nanofat with an intact perivascular structure." I wonder if that makes a difference?
Hi@@dammar117, While I do perform fat transfers in areas where the skin is thicker, I don't perform it under thin lower eyelid skin that is only 0.5mm thick because the irregularities of grafted fat like bumps can be seen through thin lower eyelid skin, as shown in the video. There are many doctors who perform this procedure, but they can't remove the grafted fat when complications occur, so their patients come to me as an oculoplastic surgeon to surgically remove it, so I know how prone to complications lower eyelid fat transfers are. I hope this clarifies things for you.
Your the only doc I have seen who is so genuine and straight up! Keep up the good work.
Thank you, Aztec Warriorz! This particular subject was important to me because many doctors still offer it, and many people ask for it, but the few eyelid specialists out there know the potential complications of grafting fat into the lower eyelids.
Amiya Prasad, M.D. I have to ask you something. I’m getting a chin implant because I have a very weak chin and weak jaw line. My dr told me the chin implant will not really help with the jawline but will definitely fix the weak chin. Do they not have chin implants that also will fix chin and jawline ? I just have been reading and many places say they do both.
Hi@@cameronjones1583,
A chin implant will also help extend the jawline and improve the angle. There are pre-jowl, and jaw angle implants available, which can be done at the same time as a chin implant, depending on the issue. However, I do prefer to improve chin project and jawline angle and continuity with long lasting hyaluronic acid fillers at the bone level. Using thicker fillers are more convenient for the patient as they don't require surgery, they are more precise, and can be used as a trial before committing to implants. Fillers can be dissolved if you don't like the look, unlike implants that require surgical removal if they don't fit properly. You can refer to these videos about it:
ruclips.net/video/dP5gLXQ9ECc/видео.html
ruclips.net/video/q-TO2t6YHGA/видео.html
Why dont you also discuss the complications of fillers, such as blindness, lumpiness, visibility, Tindel affect etc?
Hi Steven Carp,
I actually made a video about the risks of under eye fillers, including what you've mentioned. Unlike complications from fat grafting under the eyes, complications from filler treatment can be prevented with the doctor's technique, and expertise. Here's the video, for your reference - ruclips.net/video/lA6ietCvZf8/видео.html
Sir me ne 8 month pehly under eye fat grafting ki ti wo abi tak desolve nhe hoye😢
Hi@@simasher,
Sorry to hear about your problem. I don't recommend, or perform fat grafting in the lower eyelids due to the high risk of complications, but I do remove grafted fat under the eyelids placed by other surgeons. Grafted fat requires surgical removal by an experienced surgeon. I hope this clarifies things for you.
@@simasherAb kaisa h didu
@@AmiyaPrasadMD❤
I am so glad I saw this video, my surgeon was going to graft fat for my under eye hollows. I will now insist on fillers for my under eyes. Thank you so much Dr. Prasad!
You're welcome, Deborah! So happy you learned more about fat grafting under the eyes before you had it done!
33
@@AmiyaPrasadMD hello doctor iam from holland i make surgeon a fat from my body was more better then filler
Hi@@izemlinda5807,
That isn't true since filler doesn't require a blood supply, and filler can hold its shape. You can look into the video for a more detailed explanation as to why fat grafting is generally an unpredictable procedure, especially under thin lower eyelid skin.
@@AmiyaPrasadMD What about the risk to the eyes that comes with fillers?
I had Juvederm injected under my eyes for hollowness. I had a horrible delayed reaction. It began after 2 weeks. I eyes became so swollen and the product became rock hard. I had to have it all removed which took 3 sessions. The scarring took 6 months to go away. The Cosmetic surgeon that Injected me is excellent and reputable. It was my personal experience.
Hi Schmitt Rasmussen,
Sorry to hear about your problem. What particular brand of Juvederm was injected? While injectable under eye fillers are generally safe, there are still risks involved with them, which I featured in these more recent videos:
ruclips.net/video/XY7RBviX0_o/видео.html
ruclips.net/video/lA6ietCvZf8/видео.html
Hi Doc! I’m not sure if you’ve already talked about this on your other videos, but what’s your take on the recent findings that fillers don’t fully dissolve and just move around the eyes and might even cause blindness???
Hi RJ,
The risk of blindness in filler treatment is not caused by the presence of hyaluronic acid filler, but the inadvertent injection into an artery. Hyaluronic acid filler can be dissolved, but in some rare cases it may be encapsulated. You can refer to this video about the risks of under filler treatment, and how they are minimized or avoided - ruclips.net/video/lA6ietCvZf8/видео.html
@@AmiyaPrasadMD hi Doc! Thanks a lot for taking the time to respond. Appreciate it a lot. I’m on the other side of the globe and it’s unlikely I can travel anytime soon to get mine done at your clinic. It can be confusing to get varied takes on fillers vs fat graft. Good to find addtl references like your videos. Thanks a lot for sharing your expertise! More power to you and your channel!
You're welcome,@@rubiejanemontejo7573! And thanks for watching!
Hi Dr. Prasad,
This video is so informative! Thank you. I have had two consultations with two different plastic surgeons regarding my under eye issues. I have both bags and deep hollows (lucky me). Both doctors have suggested the removal of the fat bags and then fat transfer to the hollows. Needless to say, the thought of fat transfer scares me death. I had hoped that I'd only need some sort of injectable. Would you consider it safe and effective to have the bags surgically removed, but then to fill the hollows with Restylane, etc.? I'm at a loss but really want to improve the very tired and old look I've been sporting. Thank you for your time.
Love how you are so thorough in explaining everything. :) What is your opinion on fillers causing autoimmune disease or flaring an already existing one? I realize that everyone says that hyaluronic acid occurs naturally in our bodies, which of course is true. However, fillers are made in a lab. A synthetic form of a naturally occurring substance. How can they still be called safe, and why are there so many articles on people having severe, long lasting immune responses? I have thought of getting them many times, but the possible side effects are terrifying. Thank you in advance for your thoughts. 😁
Hi Chantal Loyer,
We have not seen any issues with autoimmune response to hyaluronic acid fillers. You may be referring to collagen fillers used in the past which required allergy testing before use. There are higher and more common risks related to food and water than with hyaluronic acid filler, so I hope that puts things in perspective for you.
Great video! I had Fat Grafting under my eyes in 2011. I’m so un-happy with my results now. I have swelling & lumps under my eyes now that I absolutely hate. I look like I have puffy black eyes 24/7. Seeing someone on the 28th to see what can be done to fix this. I can’t continue to live like this, I hate looking in the mirror.
So sorry to hear about your problem, Elaine Compton. I wish this video was out sooner to warn you about the procedure. I hope your surgical correction goes well.
Did you ever get your eye problem resolved?
How is it now?
gt mine done 2 weeks back ...still have evident lumps
Sorry to hear that,@@shraddhanikhil. Bumps from the inconsistent texture of grafted fat is one of the reasons why I don't recommend the procedure. If the issue persists, the only recourse is surgical removal of the grafted fat. I hope this helps you.
I had a consultation with a reputable and popular doctor and was told that I needed fat reposition with my lower lid blepharoplasty. I refused this, because I saw your video before my consultation. Am looking for a second opinion who doesn't offer this procedure, but seem most doctors do here in England. I think you would do well in England and on socal media with the great knowledge you have.
Hi Winter Blain,
I'm glad the video helped you, and you can avoid the potential complications. My patients in the US, and those that come to the US from around the world are keeping me very busy, but thanks for your confidence in me!
I trust this man with every cell of my being. 👍
Thank you so much for the trust, ⚡️presley⚡️. I glad you found the video informative.
Hi , Dr Amiya Prasad I wish I would of seen your video before I had fat injected under my eye . It was taken out of my other under eye . It caused a lump to form . An incision was made to drain the lump it has been just over a week since. The bruising and swelling has slightly gone down . The lump has slightly gone down . I was given chlorsig to use 1% for a couple of days, than to apply strataderm gel .
How can I prevent this from happening again.
Hi @stantheman3713,
Sorry to hear about your problem. Grafted fat under the eyes usually requires surgical removal. After removal, you may want to consider a treatment for hollowness with less chance of complications, such as a hyaluronic acid filler. You can refer to this video about treatment options for lower eyelid hollowing - ruclips.net/video/SF1O-tPVGO0/видео.html
Doctor Amiya, I just find this Video so happy to watch , Very helpful 👍, and Big Pardon I have a question I’m 62 it’s ok for my age to get fat grafting ??is’t high risk , and I ‘m still confuse, please let me know , can fat grafting has Side Cancer or damage face??, please let me know Thank you very much
Hi @nice9992,
I don't recommend fat grafting under thin lower eyelid skin at any age because of the high risk of complications.
Facial fat grafting such as in the mid face, or lower face also involves risk, as 30-70% of grafted fat does get reabsorbed soon after surgery, so more than one procedure is needed. If the appearance of facial fat grafting isn't what the patient wanted, then it is more difficult to reverse with surgical removal, rather than facial filler which can be dissolved non-surgically.
At your age, I would have to perform a physical examination for what I recommend for you, but it would likely be a combination of a surgical lift, accompanied by volume enhancement. I hope this clarifies things for you.
Thanks for the information. I was considering fat transfer but wouldn't go for it after this seeing video.... loved your smile at the end of the video :)
I'm glad the video helped you make the right decision, Aman N! And thank you for the compliment!
Excellent! I had been considering under eye fat grafting, though will definitely now forego it in that location, just too risky! Where as, I'm not so concerned in other non eye regions.
Hi TR_NW,
I'm glad the video helped you. You're that fat grafting in other areas is not as prone to complications as the skin is thicker, so it won't show the inconsistent texture of grafted fat. However, 30-70% of grafted fat is absorbed by the body soon after surgery, so you can expect more than one procedure to get the appearance you want. I hope this clarifies things for you.
Excellent explanation Dr. Prasad.
Your honesty and examples
Are much appreciated it.
Thank you, Patty Gavin! I'm glad the video helped you, especially in learning about a common surgery that is highly prone to complications. Thanks for watching!
Thank you, Dr. Prasad! What do you think about collagen fillers for lower eyelids? I was told that they are even better than HA fillers
Hi @e.L690,
Hyaluronic acid fillers are actually the modern replacement of collagen fillers. Collagen fillers use bovine collagen, which requires allergy testing before treatment, and some patients still don't react so well to them. Hyaluronic acid fillers are hypoallergenic in comparison, as they are well-tolerated even without allergy testing. I hope this clarifies things for you.
@@AmiyaPrasadMD thank you for the answer!🙂
You're welcome,@@e.L690
Thank you so much doctor, your video is very informative.
You're welcome, Fartemis Fartmallow! I'm very happy the video helped you!
In south korea, fat grafting under eyes are so famous, its everywhere, every clinic. How do you support that ?
Hi Ye80s,
There are more predictable and safer ways to treat lower eyelid hollowness where the skin is extremely thin than fat grafting, such as hyaluronic acid fillers. Fat grafting can still be done when the skin in the area is thicker, such as the cheeks and lower mouth. I don't perform fat grafting under the eyes, but as an eyelid specialist, I do perform corrective surgery for people who had fat grafting done elsewhere. Most of the time, doctors who perform fat transfers under the eyes are not experienced with dealing the potential complications, which leads to revisions done by oculoplastic/ oculofacial surgeons like myself. I hope this clarifies things for you.
This video has been really helpful, thankyou doctor! Can you suggest of the next best alternative for under eye hollowness and wrinkles because I can't find a specialist doctor in my area. Also, I am not keen on using fillers due to its possible side effects. Well I am just 18, so this hollowness is seriously concerning me. Are retinol creams effective?
Hi Haya Han,
Hyaluronic acid fillers are the safest way to treat under eye hollowness, and there no side effects from these types of filler if done properly. Hyaluronic acid naturally occurs in the body, so there is no risk of a foreign body reaction. As long as they are injected by an expert, there should be no issues. Retinol creams are good for moisturizing, but they are effective to add volume. If you can't find an eyelid specialist in your area, I suggest you wait until you find one, or consider travelling if you are unsure about the safety of doctors in your area. I hope this helps you.
So what fillers do U recommend for dark eyes circles then? And how often should be injected?
Hi Awesomedia,
You can refer to these videos about how I treat dark circles in my practice:
ruclips.net/video/QBvjjvxPt2g/видео.html
ruclips.net/video/S6_nTRr1tio/видео.html
ruclips.net/video/jQUb67RpaAM/видео.html
Wow. I really respect you doctor, cos you are so honest!!! Is your definition of fat grafting the same as nano fat injections? Is under eye hollowness the same as having eye bags? I am quite concerned with doing blepharoplasty for my eye bags because currently I already suffer from dry eyes and also the possible long term side effects. I am contemplating nano fat pathway. Thanks.
Hi,
Thank you for your kind words! Nanofat is still grafted fat, but with more refinement, which still behaves like fat in that it needs a blood supply to remain viable, and still has unpredictability in retaining its shape once placed in a new area. Under eye hollowness and eye bags can be related in same cases. Eyelid surgery can be done in people with dry eyes, as long as the surgeon has experience with dry eyes. Transconjunctival blepharoplasty which involves no external incision, and no lower eyelid skin removal is a safer, more predictable procedure than a Nanofat procedure. You can refer to these videos about under eye hollowness with eye bags, eyelid surgery for dry eyes, and transconjunctival blepharoplasty:
ruclips.net/video/Q0QiNH7LUVI/видео.html
ruclips.net/video/g0z5DmORXo4/видео.html
ruclips.net/video/46Kp6ayfyzg/видео.html
@@AmiyaPrasadMD Wow dr, you are amazing! Thank you I shall watch those videos. I wish you were in Australia haha! Do you think fillers can work for eye bags instead of nano fat?
Hi@@wem-c9f,
Fillers can be used instead of fat grafting, but fillers are only appropriate for mild cases of eye bags to camouflage them. Using fillers for larger bags can actually make them worse. You can refer to this video about how I choose between surgery or fillers for eye bags - ruclips.net/video/yszpZSOEGoQ/видео.html
Hi did you get it done @Dandelion_flight
Hello, Dr. Prasad! I have scheduled a consult with you for next month. Your extremely kind and professional patient coordinator, however, told me she is not sure whether you perform revision surgery to correct lower-eyelid fat-grafting complications. Since I would be driving down from Boston and the consult is not complimentary, I just thought I would ask you if you perform the procedure in general. I understand you will have to examine me in order to determine whether I am a good candidate, but do you perform such revision surgery at all? My complications are relatively mild compared with some horror stories one sees online and are limited to the lower eyelid (no upper-cheek or malar-area involvement). Thanks!
Hi G. G.,
I do perform revision surgery for complications due to fat grafting in the lower eyelids, (as you can see in the video, I do advocate strongly against fat grafting in the lower eyelids due to high risk of complications) but I do need to examine your case physically to determine if the benefit is worth the risk of surgery. No two fat grafting procedures are the same, so an examination of your case is crucial. I hope this clarifies things for you.
Thank you for this video. I had a fat transfer 6 years ago to fix hollow eyes and I have been wondering why nobody tells you what can go wrong. I have been searching for help. My transfer caused severe sagging and puffy almost like a bag under my bag. I look worse than before. I don't know what to do. I was also told I was overfilled and so I have done some Agnes RF to melt away some fat as well as RF skin tightening. Now I'm on my 3rd injection of PRF. Nothing has changed them. Do you think a skin pinch would help? I just heard that term. I am very cautious about making Decisions now. Any advice is appreciated. I warn everyone please do not do a fat transfer. Thank you for your time.
Hi Kristel LeBlanc,
Sorry to hear about your problem. I've been warning people of the high risk of complications of fat transfers under eyes for many years. I would need to perform a physical examination before making specific recommendations for you, but often what is required is surgical removal of grafted fat. A skin pinch is not often done as it involves surgical removal of lower eyelid skin, which can possibly cause a skin shortage which can make complications worse, so I only do it in rare cases. An examination is needed for a proper second opinion. I hope this helps you.
@@AmiyaPrasadMD Thank you for your response. I appreciate that very much.
You're welcome,@@kristelleblanc5459
Hi Dr Prasad. Thank you for this video. I've been looking to get my under eye wrinkles improved with erbium resurfacing, and I heard about fat transfer under the eyes. I just happened to come across your video so I am now certain that a fat transfer is not an option. I wonder if you know of any experienced surgeons in London who you may recommend for erbium laser resurfacing? I understand if you dont wish to recommend anyone, but I thought it's worth asking anyway. Thank you again for your videos. They truly are an enormous help to us all 😊
Hi NIKKI COHEN,
I'm glad you saw the video first, as you can see in the comments some people find the video after they've had the procedure done, and are now dealing with the complications.
I don't know a particular doctor in London who specializes in thermal treatments. I do advise you see a doctor who has several devices, as it shows experience, and they are not forcing one particular device on patients, but can rather select the ideal device for your specific issue, and your skin type. Also ask them what they do to prevent overheating, and overexposure.
As for the videos, you're welcome, and thank you for watching!
I had seen another video warning that synthetic tear fillers can drift from where they were originally placed.
Personally, I'd love to have some of my buccal fat injected under my eyes and into my smile lines to give my face the symmetry I had a few years ago
Hi Zikomo7,
There are different filler materials, but I prefer hyaluronic acid fillers for safety, predictability, and reversibility. If hyaluronic acid filler migrates, which shouldn't happen if placed by an expert, it does not migrate far from the original location. I don't recommend fat grafting under the eyes, as the video explains. You can refer to these videos about the risks of under eye fillers, and why placement technique is so important:
ruclips.net/video/lA6ietCvZf8/видео.html
ruclips.net/video/fwTBCiGGQs4/видео.html
I saw recently that filler doesnt dissolve. it just moves around your body. you can see it on MRIs where the filler ends up in weird places.
Hi anastasia46,
It depends on the type of filler material. Hyaluronic acid fillers are metabolized by the body, and hyaluronic acid is naturally present in the body. Permanent and semi-permanent fillers are not metabolized, and I don't recommend their use, nor do I use them in my practice. You can refer to these videos about dissolving hyaluronic acid fillers, and why I don't perform or advise permanent and semi-permanent fillers:
ruclips.net/video/a3YicyDoTZU/видео.html
ruclips.net/video/CZJ05rjav3s/видео.html
Thank you so much for this valuable information. Also, I want to know where is your office so come and see you about our Eyes problem please let me know thank you so much I saw more video about the problem but really this video was something else once again thank you so much for the information
Hi @bobjhan3197,
You're welcome. I'm glad you found the video informative and helpful.
Our offices are located in Manhattan, New York City which you can call at (212) 265-8877; Garden City, Long Island at (516) 742-4636; or Vienna, Virginia at (703) 356-1336. You can also reach us through www.prasadcosmeticsurgery.com, www.puffyeyes.com, or www.eyelifts.com by filling out a contact form, and we will get back to you. I hope to hear from you soon.
Ok thanks for the information
You're welcome,@@bobjhan3197. I hope you can visit us.
Dear Doctor. I'd like to ask you what long term treatments you think will be used in the next 10 years that may be equal in safety terms to what is advised in the video. Thanks Valerio
Hi Valerio,
Hyaluronic acid fillers done by a doctor experienced in the eye area are the safest for treating hollowness. As hyaluronic acid is naturally present and safely metabolized by the body, it cannot last any longer than it does currently. The problem with permanent and semi-permanent fillers is that they are resistant to human metabolism, and stay in the body too long as a foreign material. Silicone tear trough implants are a long-term option, but they need to be changed eventually, and many patients don't find the fit and material comfortable. I hope this clarifies things for you.
@@AmiyaPrasadMD Doctor Prasad, sorry for the delay. Thanks a lot for answering my message. Kind Regards
You're welcome,@@immunedalgregge!
Sir Is the under eye holeness effect achieved by Adipeu cream permanent or will the eyes become dull again. I'm in my 20 so I think im too young for these kind of procedures can you suggest me something I have a little bit hollowness only visible when i smile can it be cured if i gain weight
Hi @anaya1817,
I hope you understand that I can't speak for the cream you mention as it's not something I recommend, or know if it truly works. I usually treat hollowness under the eyes starting in the early 20s when the face has stopped growing. Orbital fat, which is the fat behind the upper and lower eyelids, is for cushioning and protection of the eyeball, so it's affected by weight loss, or weight gain. I hope this clarifies things for you.
Thank you for your information, what about SVF gel? Does it have as the same "unpredictable outcome" as fat grafting does?
Hi @hellishgirl6059,
SVF is still grafted fat, so it is still unpredictable in texture and shape when the fat has to take to a new blood supply. Hyaluronic acid filler is a more predictable treatment because it doesn't need a blood supply to remain viable, and its custom shape can be retained. I hope this clarifies things for you.
@@AmiyaPrasadMD Thank you!
You're welcome,@@hellishgirl6059
This is killing me slowly 😣
I got fat injection under the eye a month ago to treat my hollow eyes... Now I have visible fat which makes me look like I'm 10years older. The surgeon told me he will inject a fat dissolving agent on it but he fears that he might creat a hollow/depression on my face🤦♀️. Please advise me what's the best thing to do. I have not left my apartment ever since because of the way I look. This is really killing me. I regret BIG TIME. This is the biggest most horrible lesson of my life😣😣.
Hi Viktoria Vicky,
Sorry to hear about your problem. I would need to examine your lower eyelids to determine what the best treatment is for you. I made this video to help people avoid fat transfers in the lower eyelids because of its high rate of complications. Fat grafting in this area may require surgical removal or revision, but this can be determined in an examination. I hope this helps you.
Hi Victoria, how are you doing now ? Did you fix your problem?
Another doctor said fillers are terrible. The filler eventually goes to other places in the face causing it to look puffy. Example: Kylie Jenner.
Hi jja91785,
The results of filler, or its migration, are determined by the skill of the doctor applying them, so a doctor good at filler application can avoid migration. I actually made some videos about these concerns, for your reference:
ruclips.net/video/Brb4uTzzG88/видео.html
ruclips.net/video/kpkIuOXkloI/видео.html
ruclips.net/video/CWhtFHVifgk/видео.html
Great and informative video. May I ask how fat grafting under the eyes compares to fat mixed with stem cells injected in the same region? Is the mixture a safer option? It seem to look the most natural (not just in theory) than all the other options. Thank you for your time.
Hi Sue S.,
Fat grafting and fat grafting with stem cells are both pretty much the same thing. Yes, fat is natural, but fat naturally needs a blood supply to remain viable, and fat naturally has a lumpy and inconsistent texture, which can be seen through thin eyelid skin. Hyaluronic acid fillers are more predictable for texture, consistency, and end results, and don't require a blood supply. Hyaluronic acid also occurs naturally in the body, so they are hypoallergenic. These fillers can also be applied in minutes without surgery. I hope this clarifies things for you.
Thank you Dr. Prasad, It does clarify things, thank you! Where do you think it's safe to inject fat on the face? I was told that the stem cells need something to bind to in order to work and that on their own it's a bit pointless. As a person with a naturally thin face from day one added to a lot of volume loss due to ageing and endurance sports, I tried filler and I looked puffy and not at all like myself. I had it removed.
It made a lot of sense to me what you mentioned about putting filler where bone loss occurs, can one do that with fat?
Hi Sue S.,
Facial fat transfers are safer where the skin is thick, such as in the mid face like the cheeks, nasolabial, and mesolabial folds. However, facial fat transfers are still not predictable as 30-70% of fat is absorbed soon after the procedure. Facial fillers are more predictable because they are metabolized gradually, and can be shaped, unlike fat.
Fat cannot be placed at the bone level, but fillers can, but not many doctors place filler at the bone level. You can look for Y Lift-trained doctors to place it at the bone level. I am among the first Y Lift-trained doctors, and call my style Structural Volumizing as it restores volume at the structural bone level of the face. You can review how I place it, and the results in these videos:
ruclips.net/video/CWhtFHVifgk/видео.html
ruclips.net/video/Brb4uTzzG88/видео.html
Thanks for this video! So for tear trough situation, it's best to just go for fillers instead of fat graft then?
Hi Aldrin Allanigue,
Yes, fillers are more predictable and safe for the under eye area than fat grafting.
@@AmiyaPrasadMD nice. didn't know this, your video has lots of information. How long do you think fillers will last?
Hi@@aldrinallanigue3671,
Softer hyaluronic acid fillers, which are the safest to use, like Restylane-L or Juvederm XC last about a year. I hope this clarifies things for you.
@@AmiyaPrasadMD about a year? so will it go back the same it ever was? or partly will there be any of the fillers left after a year?
Hi@@aldrinallanigue3671,
It depends on how fast you metabolize the filler, as it does vary between people. I hope this clarifies things for you.
Thank you for honesty!
Glad you liked the video, caughtinamosh!
Dr. Prasad, can you recommend a surgeon in Las Vegas to do this procedure?
Hi steven elton,
What procedure are you asking about? I don't recommend fat grafting under thin lower eyelid skin because of the high risk of complications. While I do know colleagues in Nevada, we all have different aesthetic styles, and practice focuses. I suggest you look at before and after pictures of the doctors in your area, and consult a doctor whose results, and individual style resonate with you. I hope this helps you.
Thanks GOD for sending you doctor, one doctor recommended me do all fillers to fix tear through and also archive golden ration on my whole face while other doctor recommended remove eye bag, then fat grafting to whole face include tear through. I a, nervous about tear through area so I am happy to find your advise
Hi BiBi Beauty,
I'm glad you had some healthy skepticism, as well as finding the video as fat grafting under the eyes is really not work the high risks involved in the procedure. I hope you did reach the part about treating the tear troughs more safely with cosmetic fillers, but in addition we do have this other video about treating under eye hollowness - ruclips.net/video/VzzsbNDlaHQ/видео.html
What would you recommend for eye brow filler? I have lost some volume in my eye brow (above upper eye lid) and would like to try and get this rectified. Many thanks
Hi Fishermans Friend,
I actually did make a video about that, for your reference - ruclips.net/video/dCDRBngaq60/видео.html
From the time you made this video, has fat transfer technology/technique, evolved enough to be safe around the eyes? Have the use of stem cells been explored to help with this procedure? To be honest, I would never do fillers because I’m looking for a more permanent result. I just want to replace the fat that my body lost around the eyes, but I want to do it safely. So, I’m wondering if any plastic surgeon has mastered how to do fat transfer around the eyes yet.
Hi @chariots8x230,
The behavior of grafted fat hasn't changed - its texture and consistency are still unpredictable once fat is removed from its original blood supply, and has to take to a new blood supply.
Almost all medical cosmetic procedures are not permanent because aging still continues if you have a procedure. You can refer to this video about - ruclips.net/video/TzQOCp5RRzU/видео.html
And polynucleotide biostimulators could be an alternative to hyaluronic acid filler in the malar sulcus? Or use the two in combination? Especially in a young patient.
Thank you 😊
Hi Carolina Villacis,
Polynucleotide biostimulators are not FDA-approved in the US where I practice medicine.
So you do recommend the fat grafting undereye in the upper part but not the lower part due to
Complication and also how long would the fat grafting under eye last?
Hi zanyar 122334,
The skin above the upper eyelid/lower brow is thicker than lower eyelid skin, so it doesn't show the inconsistencies in texture in grafted fat such as lumps that would show through the lower eyelid skin.
While I don't perform fat grafting in the lower eyelids, as an eyelid specialist I do surgically remove grafted fat in the lower eyelids that was placed there by other doctors, so I still see this complication often. I hope this clarifies things for you.
Great video Dr. Prasad..!!
If you don't mind, I have a quick question about fat grafting: When doing fat grafting on your face how high in the cheeks can it be applied away from the under eye area?
Hi varispujols,
If fat grafting is chosen for the face, it should be limited to where the skin is thicker, so at most at the mid to upper cheeks. Keep in mind that filler can also be used in the cheeks, and since filler is metabolized gradually, and doesn't need a blood supply, the shape and results are more predictable. 30-70% of grafted fat is absorbed quickly by the body following a fat grafting procedure, and fat has inconsistent texture that affects shaping. I hope this clarifies things for you.
@@AmiyaPrasadMD Thank you.
You're welcome, @@geek2330!
Would you suggest lasers/PRP procedure over fat grafting for under eye dark circles? Please let me know as I have contacted a few doctors and they only provide fat grafting services.
Hi @meenienegi4319,
I don't recommend fat grafting at all for treating under eye dark circles, and you can see in the video the high risk of complications involved in fat grafting under thin lower eyelid skin. Even though I don't recommend or perform lower eyelid fat grafting, I see many patients who had this procedure come to me because their original surgeon can't remove the grafted fat when complications occur.
Under eye dark circles can be caused by pigmentation, pooled blood, iron deposits, or thin eyelid skin revealing the darker anatomy behind the eyelid.While a physical examination is needed before making specific recommendations for you, these videos feature the ways I treat under eye dark circles in my practice:
ruclips.net/video/QBvjjvxPt2g/видео.html
ruclips.net/video/S6_nTRr1tio/видео.html
ruclips.net/video/jQUb67RpaAM/видео.html
ruclips.net/video/RHJodb437o4/видео.html
I wish I lived in New York/US and could come and see you!
Thank you, Lilmisscostumedrama! We do have patients coming from around the world (under normal travel circumstances), so you can join our international patients, if you wish.
Mr Dr., Radiesse is better than hyaluronic acid to correct hollowing under the eyes?
Hi Ionescu Ion,
Softer/less viscous fillers are required for the under eyes as this area has a lot of movement with facial expressions, and Radiesse is a more viscous/ stiffer filler. Radiesse also has its own potential complications as the material calcium hydroxyapatite does not completely metabolize, so some of the material may always remain in the body, and even migrate. Hyaluronic acid is completely metabolized with time, and can be dissolved when needed. I hope this clarifies things for you.
Can you recommend a dr in the Los Angeles area?
Hi Bella Rose,
Although I do know colleagues in the LA area, we do have different styles and specialties. I suggest you look at the results of prospective doctors, and stick wit one you trust. I hope this helps you.
what about redistributing fat under the eyes to make hollowing/tear troughs less obvious? (as opposed to taking fat from other parts of the body)
Hi @clouds8D,
That is called fat repositioning/ transpositioning, which I detail in this separate video - ruclips.net/video/m-_mFe4eWmo/видео.html
Fantastic video! Thank you, Dr.
You're welcome, bslomof -1! I'm glad you found the video informative!
Hi doctor
The fat grafting in this video means stem cell fat transfer? I was thinking of this surgery to give the overall volume to the face and for skin rejuvenation. Do you recommend this procedure?
Hi H Owen,
Stem cell procedures usually just mean fat transfer/fat grafting. While I have performed facial fat transfers in the past, but not under thin eyelid skin, there are other options and factors to consider when thinking about a "stem cell" procedure, which can be reviewed in this recent video - ruclips.net/video/eoiMTOU0A0A/видео.html
Thank you dr for your informative input.
I have hollow under eyes and big space under my eyes that filler failed to fix. Can i do lower blepheroplasty to cut down excess skin and lift my mid face upward ? Cuase i tired mid face filler also didnt work either
Hi @alal85831,
Removing lower eyelid skin results in a host of complications due to a skin shortage, from lower eyelid retraction, ectropion, entropion, rounding of the eyes, change of eye shape, etc.. A physical examination is needed to determine the best approach for your case. I hope this clarifies things for you.
I have hollowness/volume deficiency not directly underneath the yes, but in my midface/cheek area, forming what I believe is called a mid-cheek groove? I've seen two oculoplastic surgeons with good credentials who treat this area with fat transfer. Is this still "not adviced" or would that be a different situation? I just don't feel like they would do this regularly and revolve their practice around fat grafting to this area if it was that ill-adviced? I could consider fillers if I knew any injectors in my area, but there are none, so I can't fly out of country every few months to get fillers..
Hi Julian Nikolay Krogh-Fredriksen,
The mid cheeks are different when it comes to fat transfer because the skin there is thicker. I have performed fat transfer in the mid-cheeks and lower mouth. However, you would have to consider that fat transfer is a surgical procedure, and you may need at least two procedures as 30-70% of transferred fat is absorbed by the body. I hope this clarifies things for you.
Can you please give me your opinion on TEAR TROUGH IMPLANT for hollowness under eyes
Hi Johanna Sanchez,
I do perform tear trough implants, which I insert through the transconjunctival method, so there is no external incision. Tear trough implants are not permanent because facial volume and proportion changes with age, so the implants will need to be changed after some time. I do find filler to be more convenient for patients as it involves no surgery, and fillers are very flexible with facial expressions like smiling, so they look very natural. I hope this clarifies things for you.
Hi doctor, is it possible to minimize the risk of fat transfer if it's done by an experienced doctor and with a conservative amount of fat over multiple sessions? I have small hollows both above and under my eyes and getting fillers for both every year would probably be really economically taxing, so i really wish for a more permanent solution
Hi Andrea Marteddu,
As an oculoplastic surgeon who revises fat transfers under thin lower eyelid skin performed by other doctors, I can't recommend it because it is too unpredictable, and too prone to complications. I have done it in the upper eyelids/lower brow where the skin is thicker, but it usually requires a repeat surgery due to 30-70% of fat not taking, or being absorbed soon after surgery. I hope this clarifies things for you.
And here i was all excited about saving up for facial fat grafting (nasolabial folds, forehead and under eye wrinkles). *sigh*
Hi Pink Horizon,
Fat grafting can still be performed where the skin is thicker, such as the nasolabial area and forehead, but this video is a warning for fat grafting in the lower eyelids, which is the thinnest skin of the body and can show the inconsistency of the fat's texture. I hope this clarifies things for you.
@@AmiyaPrasadMD Thank you. It does. I'm just a bit nervous since there is a chance of lumps developing (risks of surgery, right?) and it cannot be dissolved compared to fillers. So there is lots to think about.
Dear Mr Prasad do you recommend fat transfer to the face at all? I am deciding between fillers and fat grafting after years of running I have a very thin face. I feel that the fillers are too short term and would cost more in the long run compared with a fat transfer to face. Can you give your opinion? Thank you Georgina
Hi gina Veale,
I do perform fat transfers to areas of the face where the skin is thicker, but I have been using longer lasting fillers more lately. Understand that fat can also be absorbed by the body so it's not permanent, and fat transfer is a surgical procedure, so it can be more costly than filler application in the long run. Cosmetic filler treatment is more predictable than fat transfer, and it can be done in minutes since there is no surgery involved. I hope this clarifies things for you.
Fascinating video, doctor.
Thank you, Kevin Hanley. I'm glad you found the video interesting.
Hello, is there anyway to get even a rough estimate of the cost of your tear trough procedure for hollows? Being in Manhattan I'm sure u can charge plenty. Pls reply Dr.
Hi Lora A,
You can contact our office directly regarding price range. You can call Manhattan at (212) 265-8877, and Garden City, Long Island at (516) 742-4636. You can also reach us through www.prasadcosmeticsurgery.com, www.eyelifts.com, or www.pufffyeyes.com by filling out a contact form, and we will get back to you. I hope to hear from you soon.
I had an upper and lower blepharaplasty done about 6 months ago. There are lumps on my upper lids and the surgeon did a medial incision on my lower eyes. Not happy. I have a visible scar. I was told it would eventually not be noticeable in time as I continue to age and just blend in. I am 66. Any recommendations? The scar bothers me. I hope I am saying this right - my cheeks are wrinkly and at times I have slight malar bags. Would fillers help this problem. One more thing - if you have fillers routinely, will the skin stretch and be worse? Thanks
Hi Vanessa Wood,
I would have to perform an examination before recommending specific procedures that would help you. However, I can answer that filler does not stretch the skin, and I did make a video about it, for your reference - ruclips.net/video/hx540qDFbrs/видео.html
what type of filler do you like under eye? I had bad luck with vallure.
Hi Farah's Mirage,
The brand of filler doesn't determine results, but it's the doctor's expertise, technique, and experience that determine results. Think of filler as the material, or in the case of sculpting, it’s just the clay. The clay itself doesn’t determine the sculpture, it’s the sculptor, or the doctor that determines the final appearance. You can refer to this video about it - ruclips.net/video/fwTBCiGGQs4/видео.html
Hi Doctor, can you recommend doctor in India. Travelling to US not feasible for me
Hi GT,
Doctors have different practice focuses, so it's hard to recommend one. I suggest you look for a doctor who is experienced in what you want treated, and look at their before and after pictures to find an aesthetic style that resonates with you. I hope this helps you.
Hi dr...I’m 35 years old and I don’t have bags or hollowness under my eyes, but I do have very noticeable wrinkles under my eyes, especially when I smile, what is the best treatment for that?
Hi MinhChau Nguyen,
I generally don't recommend treatment for skin bunching under the eyes when smiling, and best treatments can only be determined after a physical examination which also assess your skin type, but you can refer to this video on how I generally treat wrinkles around the eyes -
ruclips.net/video/PXMhY90TReM/видео.html
@@AmiyaPrasadMD thank you dr, I’m going to watch that video.
You're welcome, @@minhchaunguyen2853!
I have had fillers put under my eyes, twice. Both times my body metabolized it (?) within a few weeks. Then I got fat grafts, and now, four months later, those too are gone. Very frustrating!
Hi Katharine Lang,
Sorry to hear about your problem. I've actually had many patients complain about the same thing when having filler applied by other doctors, and with a change in placement technique, and perhaps type of filler, we can achieve longevity of filler of about a year. I hope this helps you.
Would you say to avoid fat transfer in the cheeks, next to the nasal bridge? I am looking at both submalar implants and fat transfer to create anterial volume due to my unnatural cheek placement
Hi Laura Thomas,
I only advise against fat transfer under thin lower eyelid skin, but I have performed fat transfer in the cheek area. For fat transfer, you do need to factor that 30-70% of transferred fat will be absorbed, so prepare for at least two surgeries. I would also recommend you consider filler for cheek volume, which can be done without surgery in minutes and last up two years. You can watch this recent video about it: ruclips.net/video/GlF2ePf1AGw/видео.html
Tks so much for your information. So is it a good way to improve pennis girth?
Hi Long Tran,
Sorry, I don't do such procedures in my practice, so I wouldn't be the right person to comment on it.
LMFAO
Dear doctor, isn't both fillers and fat grafting risky? .fillers migrate and sometimes imcan be difficult to remove.
Hi @manurasamarasekara2821,
The risks for fat grafting in the lower eyelids, and filler in the lower eyelids are not the same as the shape, and texture of filler are far more predictable than grafted fat. Risks of under eye filler have more to do with technique in which it's applied rather than the predictability of the material. You can refer to this video about the risk of under eye fillers - ruclips.net/video/lA6ietCvZf8/видео.html
Hey Dr. What are your thoughts on nanofat for under the eyes?
Hi Jen Davis,
Nanofat is still grafted fat, and once fat is removed from its original blood supply, it does behave unpredictably in terms of its consistency of shape, and taking to a new blood supply, so the potential complications are still the same as is shown in the video. I hope this clarifies things for you.
Good more of this please
I'm glad you found the video helpful, Johan Heyns. You can refer to these videos about the safer, more predictable options to treat under eye hollowing:
ruclips.net/video/VzzsbNDlaHQ/видео.html
ruclips.net/video/Q0QiNH7LUVI/видео.html
ruclips.net/video/46Kp6ayfyzg/видео.html
ruclips.net/video/m-_mFe4eWmo/видео.html
Doctor, filler results last like a few months and they migrate easily, isn’t fat grafting better if you don’t have much fat around the eye? Especially if done by a very experienced doctor with decades of experience, and does lump only appear when they put too much in at once and not little cc at a time? I heard only 50% of the fat survives so they usually overfill? Is there many cases of good results or are you saying this because majority of the results are failures?
Hi @trentlaststand4574,
As explained in the video, this is why I don't recommend fat grafting under the eyes:
- the shape and texture of grafted fat can be irregular and lumpy once removed from its original blood supply
- thin lower eyelid skin (0.5mm thick) can show the lumpy texture of grafted fat
- as an eyelid specialist, I often surgically remove grafted fat under the eyes because the patient experienced the above. Doctors who place grafted fat under the eyes often can't remove it if complications occur.
Hyaluornic acid filler under the eye is more predictable as it doesn't require a blood supply, the shape and texture are customizable, and if migration does occur, it doesn't migrate far from the original position. Hyaluronic acid filler can be dissolved if needed, while grafted fat requires complex surgery to be removed when complications occur. Incidence of complications are much higher with grafted fat in the lower eyelids than with hyaluronic acid filler. I hope this clarifies things for you.
@@AmiyaPrasadMD i went to consult plastic surgeon today and he does not recommend dissolving filler as it could potentially destroy the skin, I was gonna dissolve it to get fat grafting.
Why does filler always migrate around the temple or near the tear trough but not the cheeks? This is the only reason why I considered fat grafting. I never had trouble with fillers near the cheeks it stays and doesn’t really migrate. My thin lower eyelid is actually very thin genetically i can see the blood vessel, is there a way to thicken skin here without grafting?
Hi@@trentlaststand4574,
I don't think that dissolving filler affects the skin significantly, and made several videos about it for your reference:
ruclips.net/video/P2a23JIrf6w/видео.html
ruclips.net/video/-xepTFX83Lc/видео.html
ruclips.net/video/a3YicyDoTZU/видео.html
How about fat graft on forehead nose bridge tip of the nose and chin area. When to see the final result? How long the fat will dissolve in these areas. Coz i dont want them anymore. The fat transfered on chin pull down my lips😢
Sir but filler is usefull only for 1 year? And after one year again I have to take it??? And also tnxx alote......
Hi @richapandey7646,
Hyaluronic acid fillers are meant to metabolized after about a year for safety, as semi-permanent, and permanent fillers are prone to foreign body reactions, and infections. Silicone tear trough implants are an option, but many people find them uncomfortable, as opposed to hyaluronic acid fillers feel more natural. I hope this clarifies things for you.
Than what is the best way to get rid of dark circles
Hi Aman Keahri,
I have done some videos specifically about dark circle treatment, and you can watch these latest ones:
ruclips.net/video/S6_nTRr1tio/видео.html
ruclips.net/video/QBvjjvxPt2g/видео.html
ruclips.net/video/jQUb67RpaAM/видео.html
What do you think about PRF injection under the eyes?
Hi @albintangring1110,
PRF is great for improving skin quality, texture, and thickness. However, the volume effect of PRF only lasts about 3 weeks, so it's not a replacement or alternative to hyaluronic acid fillers. You can refer to this video about it - ruclips.net/video/5f7_CLtYzNY/видео.html
Hi Dr, I'm confused as to why some doctors/surgeons say dermal fillers can last a good few years, but youy're saying it only lasts up to a year?
Hi Randoindabando,
There are different materials used in cosmetic fillers. I am describing hyaluronic acid fillers, which are the safest to use because hyaluronic acid naturally exists in the body, so they are biocompatible, and are metabolized safely. Metabolization is a good thing because if they last too long, your body can have a foreign body reaction to the filler material, and treat it as an infection. Also, fillers that stay too long in the body can break apart and migrate into deeper tissue where they can't be fully removed if there are complications. You can refer to this video about why I don't administer, or recommend semi-permanent, and permanent fillers due to high risk of complications - ruclips.net/video/CZJ05rjav3s/видео.html
Is fat grafting with prp comparable in predictability to that of hyaluronic acid fillers?
Hi Britney Lopez,
The addition of PRP does not change the unpredictable behavior of grafted fat, as grafted fat still needs to take to a new blood supply, and cannot hold a consistent shape once removed from its original blood supply, so the uneven shape and texture can still be seen through thin lower eyelid skin. I hope this clarifies things for you.
Hello Dr. May I have your thoughts on CO2 laser on lower lids in conjunction with lower lid blepharoplasty? I see quite a few oculoplastic surgeons performing this. Does it leave unresolved redness or discoloration? Is it even needed? Thank you.
Hi Matt Smith,
That is the same approach I would take. You can refer to these videos about treating eye bags, and under eye wrinkles separately:
ruclips.net/video/46Kp6ayfyzg/видео.html
ruclips.net/video/U7kJ4CMcJ0A/видео.html
ruclips.net/video/PXMhY90TReM/видео.html
@@AmiyaPrasadMDyes but what if one has darker skin? I’m Asian.
Hi@@tinachxx110,
I recently made a video about laser alternatives for darker skin, for your reference - ruclips.net/video/8kTve_tEBaI/видео.html
I suffered an orbital floor fracture 5 years ago. My orbit healed on it’s on. However, I have a sunken in look under that eye. What do you recommend? I’m looking for something more permanent that doesn’t migrate.
Hi H Hatesincels,
Sorry to hear about your problem. I would have to examine your lower eye area before making a specific recommendation, but understand there are no "permanent" solutions as even tear trough implants won't fit eventually as facial dimensions change with age due to age-related volume loss. You can refer to this video about the different treatments for hollowing under the eyes - ruclips.net/video/VzzsbNDlaHQ/видео.html
Hi Mr Amiya Prasad. I wrote to you 1 month ago about my problem. 5 month ago I did lower blepharoplastic. But I don’t like it . Because now I have very big hallowness under my eyes. I have heard about polylactic injection for filling the under eyes. Is it good for my problem. Thank you very much for your response
Hi @OzodaSuyunova-bz1uz,
Poly-L-lactic acid treatments rely on a biological reaction in the body to create volume, so they are not as predictable or precise as hyaluronic acid fillers featured in the video. I hope this clarifies things for you.
Hi how are you? Mr Amiya Prasad. Can i send you my picture? For getting advice from you. Because I live very far from you and our plastic surgeons in my country’s very inexperienced ? I am nervous now
Hi@@OzodaSuyunova-bz1uz,
I hope you understand that I can't give treatment recommendations based on pictures alone as they don't reveal the anatomic details I need. Pictures help, but they can't replace a physical examination.
My sister developed what looks like a xanthelasma like appearance after fat transfer filler. Does this ever dissolve on it’s own? I feel bad for her, it looks awful .. are there any non-surgical solutions ? If not, can there’s be lasered out? Or treated like xanthelasma removal ? Thank you
Hi Debbie Eberhart,
I would have to examine it first before recommending treatment. Since grafted fat does behave unpredictably once removed from its original blood supply, it can appear lumpy and irregular, which can be seen through thin eyelid skin since it's only 0.5mm thick. I would have to properly diagnose the issue before recommending specific treatments. I hope this clarifies things for you.
Hi.please answer me, i use derma roller under my eyes and now i have a lots of wrinkles just under my eyes. How can i treat them please. I think filler or botox it is no good just under i mean the erea directly under eyes. Please give me an advice
Hi @Nuumidia,
Sorry to hear about your problem. Use of a dermaroller without proper training usually results in overly aggressive use, and not enough time between sessions for healing. While an examination is needed to determine the best treatment approach for you, you can refer to this video of the different treatment options for under eye wrinkles in my practice - ruclips.net/video/PXMhY90TReM/видео.html
THANK YOU FOR THIS VIDEO!!!
You're welcome, SelfLoveU! Glad you found the video helpful!
Hello doctor...is there any filler which can last forever....you are saying that it lasts for 1 year only...then what is the fun of using it...even fat grafting lasts for a quite more time than fillers...then who is going to get injected year after year with the fillers
Hi Royal Boy,
Permanent and semi-permanent fillers are highly problematic because the body reacts to them as a foreign substance, so infection, rejection, swelling, and migration are usual bodily reactions to them. The reason why other fillers are temporary is because your body metabolizes them safely, while permanent fillers resist metabolization. You can refer to this video more about it - ruclips.net/video/CZJ05rjav3s/видео.html
Thanks doctor.....doctor I have a facial asymmetry...can u correct it
Hi@@mrcruel8910,
Facial asymmetry is natural and normal, and everyone has it, including actors and models, so it doesn't need to be corrected if there is nothing wrong with it. It is usually unnoticeable by others. I only advise treatment for facial volume changes due to aging, or if there is a genetic volume deficiency. You can refer to this video about it - ruclips.net/video/DpTPMpi_t3s/видео.html
Good question
Can you do an episode on the face areas that can use your own fat?
Hi Nga Nguyen,
I understand why people may prefer fat as it's a natural material. However, once fat is removed from its original blood supply, it is an unpredictable material to work with. Fat grafting/transferring can be done in areas where the skin is thicker, like the cheeks, where it won't cause the same complications as in thin lower eyelid skin. However, fat is unpredictable in maintaining a shape, and 30-70% of transferred fat can be reabsorbed soon after the procedure. Transferred fat also requires a blood supply to remain viable, and if it doesn't take to a new blood supply, it will be absorbed. Hyaluronic acid fillers are more predictable in retaining a shape as they don't require a blood supply. Hyaluronic acid does naturally exist in the body, so these filler materials are safe to use, and are metabolized with time, but not as quickly as fat. Filler treatment also requires no surgery, unlike fat grafting that requires surgery to graft, and surgery to place it in a new area. I hope this clarifies things for you.
So what can you suggest?
Hi Heena Desai,
I hope you understand that I would have to physically examine your wrinkles, and determine your skin type before making specific treatment recommendations for you. I sent you videos on your other comment to show the different treatment options. I hope this helps you.
But even hyaluronic acid absorbs water a lot and causes puffiness under the eyes with time. Are there any solutions regarding this matter?
Hi Sissi Modanisa,
Hyaluronic acid fillers attracting water is well known among doctors, so experience in placement, and knowing the right amount of material used are important. We follow up with filler patients two weeks after placement to see results after the filler material has settled, and enhance further if needed, and provide guidance about the behavior of hyaluronic acid filler when it comes to water. Hyaluronic acid fillers used in the eye area last about a year before being safely metabolized by the body. I hope this clarifies things for you.
I had a consultation with an oculoplastic surgeon who was unable to give me a lower lid blepharoplasty because I don't have enough fat to work with under my eyes and while he said I do have some slight puffiness I also have a tear trough deformity. He suggested at first getting fillers but then told me it's probably not the best option for me as I have thin skin under my eyes and they'd most likely show through and this is what he suggested after that, getting fat transfer but after watching this video I'm questioning whether it's too much of a risk that will likely not pay off? I'm really lost as what to do next.
I'm 29 and it's no understatement when I say how awful I look, part of the problem I think is that naturally I'm a thin person and so is my face but I've had this all my life and I'm so confused what to do about it.
Hi Ashley,
Sorry to hear about your problem. It doesn't make sense to me that a doctor would say fillers can be seen through thin eyelid skin, and recommend a fat transfer instead since grafted fat has more irregularities than filler, and would be even more visible through thin eyelid skin. I would still highly advise against a fat transfer under eyes. If you can't come see me for a physical evaluation and a second opinion, I suggest you do with another doctor experienced with filler under the eyes. I hope this helps you.
@@AmiyaPrasadMD Thank you for taking the time to respond and for making this video as it's given me useful information I can take with me going forward. I'm now seriously considering fillers as an alternative for now and possibly think of surgery when I'm older but fillers still make anxious due to the risk of blindness, I know it's rare but every time I get it done I feel that risk increases. Unfortunately unable to visit you at your clinic as I live all on the other side of the pond in the UK but may I ask one final question, I've read Restylane is the best option for tear trough fillers while Juvederm has some disadvantages which I read from a Dr Steve Weiner (thecinique.com), would you agree with that? Most clinics near me use Juvederm.
Hi@@ASHERZ7167,
I use both Restylane and Juvederm for the under eye area, as it's technique that determines results more than the brand of filler. You can refer to this video about the risks and expectations of under eye filler treatment - ruclips.net/video/lA6ietCvZf8/видео.html
100% agree with you doctor!
I hope you didn't find that out the hard way, Tezeta Nishan! Fat grafting under the eyes is still very commonly practiced, so I hope more people learn about its risks.
Im 29 yrs old, my hollowed upper and lower eyes caused me some stress and insecurities, i look totally different, what is the best permanent lasting natural treatment
I don't like fillers
Could stem Cell be a solution
Hi @SciDiscoveryNews,
I hope you understand that expecting a permanent treatment is unrealistic, as we can't stop aging, and volume is lost throughout the face due to aging. Stem cell treatments are limited, and are not usually administered in cases to treat volume loss. Tear trough implants can be placed in the lower eyelids, but many report that they don't feel as comfortable or as natural as filler, and eventually they will need to be replaced as our faces can smaller due to aging. You can refer to these videos on how treat under eye hollowness in the lower, and upper eyelids:
ruclips.net/video/SF1O-tPVGO0/видео.html
ruclips.net/video/dCDRBngaq60/видео.html
ruclips.net/video/Q0QiNH7LUVI/видео.html
ruclips.net/video/C1pxoU7e1SE/видео.html
@@AmiyaPrasadMD hi doctor, thank you so much for taking from your time and answering, what I meant by permanent is that they will age Naturally with time and not disappear completely just because 2 years passed or something like fillers.
I have struggling with hollowed eyes since age 25 due to staying up too late since then my face looks so different, the charm has gone in early age unfortunately
Hi@@SciDiscoveryNews,
While there are thicker hyaluronic acid fillers that can last longer than a year, they are not meant for the under eye area because thicker fillers are meant for the cheeks, chin, and jawline that have little to no movement with facial expressions. Permanent and semi-permanent fillers are highly prone to complications like infection, and foreign body reactions from staying in the body too long without being safely metabolized. As I said previously, silicone tear trough implants are a possibility for longer lasting volume, but many people who end up having them find them uncomfortable. You can refer to this video about the high risk of complications from semi-permanent, and permanent fillers - ruclips.net/video/CZJ05rjav3s/видео.html
How could you be in practice so long but look so young?
Thank you for your kind words, fjayney1! I'm flattered!
Maybe because he is a doctor specialized in beauty?
How about Blepharoplasty? Is it safe?
Hi Wendy Esther,
Lower blepharoplasty is mostly performed for puffiness under the eyes. In some cases, puffiness can cause the adjacent area to look hollow in comparison, so blepharoplasty is the right treatment for relative hollowness in these cases.
The safety of lower eyelid surgery depends on the expertise, and experience of the doctor, and technique is also important in the safety. Lower eyelid skin removal, and compromising lower eyelid support structures are the most common causes of complications. You can refer to this more recent video on how lower blepharoplasty can be done more safely - ruclips.net/video/URMaUf-hRsA/видео.html
Very helpful. Thank you 🌻
You're welcome, Victoria! I'm glad you found the video helpful!
Excuse me doctor, do you think fat grafting above the eyes can cause the same problems?
Hi Michele Albanese,
The skin above the eyes is thicker than lower eyelid skin, so the issues with lumpiness of grafted fat doesn't occur. I actually have performed fat grafting into the lower brow in the past, but the problem is more with 30-70% of fat being reabsorbed by the body soon after the surgical procedure, so it less predictable than a non-surgical filler treatment. You can refer to this video for more about it - ruclips.net/video/dCDRBngaq60/видео.html
@@AmiyaPrasadMD thank you so much doctor 👍
You're welcome, @@michelealbanese3261!
hi doc , is it safe to have fat grafting on my right eye socket? i have bone fracture and my face became hollow especially my eye socket. I will have Lateral Canthopexy surgery bcoz of my scleral show , and also fat grafting for eye socket. i wanna know if it will look okay or natural in the long run? Thank you
Hi @Mixia02,
As explained in the video, I don't recommend fat grafting behind the lower eyelids because of the high rate of complications due. Grafted fat can become lumpy, and has an unpredictable shape when removed from its original blood supply, and this can show through thin eyelid skin. I do recommend injectable hyaluronic acid fillers instead of fat grating. I hope this clarifies things for you.
Is nanofat grafting a more safer then typical fat grafting for under the eyes. How common is complications?
Hi Daisy Fish,
Nanofat may reduce complications like lumping since the fat is processed to be more fine, but it still needs to take to a blood supply before providing volume. Fat absorption by the body is still an issue with Nanofat, so the process is less predictable than filler, and may require subsequent treatments soon after the first. I hope this clarifies things for you.
@@AmiyaPrasadMD I had Restalyane Silk for under the eye hollows, and hated it once the swelling went down. I couldn't wait for it to dissolve it took over 2 years to dissolve but I still see it sometimes in the mornings. Never again.
Sorry to hear that, @@minkycat66. For results, placement technique is more important than the filler material itself. The filler is just the material, while it is the doctor's skill, experience, and artistic style that determines the appearance. The doctor's skill also determines how well the material is dissolved with hyaluronidase. I hope this helps you.
And what about nanofat ??? Thank you
Hi By Isnata DIY,
Nanofat is a process for filtering grafted fat, but it doesn't change the fact that grafted fat still needs to take to a blood supply to be viable, and the shape and texture of grafted fat can still be inconsistent and unpredictable once removed from its original blood supply. I hope this clarifies things for you.
@@AmiyaPrasadMD ok thank you
You're welcome, @@byisnata
I have a question dr. Prasad, If one gets fat grafting regardless of where it is, would it disappear if one looses weight and come back again if gained weight again? Or is there places this wouldn’t happen - if it happens at all?
Hi Sasannide,
It's important to understand that with natural fat, you don't lose fat cells when you lose weight, but the fat cells do shrink in size and volume. Grafted fat behaves differently as 30-70% of grafted fat doesn't take to a blood supply, so those fat cells can be lost entirely soon after the procedure. Grafted fat cells that do take to a blood supply will also lose and gain size the same way native fat does. I hope this clarifies things for you.
What about fat grafting for lips? I have seen great results!
Hi Naina,
While the complications may not be as severe as fat grafting under thin eyelid skin, grafted fat is still unpredictable once removed from its original blood supply, so it doesn't hold a consistent shape, or provide a predictable amount of volume. I would still advise a hyaluronic acid filler instead that doesn't require a blood supply, and can maintain a predictable shape. I hope this clarifies things for you.
i have done ft in my whole face and around eyes i love the results but started fading days post up can you tell me how to keep it please
Hi realite miracle,
The results from temporary swelling after the procedure, as well as the absorption of 30-70% of grafted fat quickly by the body should have been explained by your performing doctor. Quick absorption of grafted fat by the body is usually why 2 or more facial fat grafting sessions are needed for desired results. Gradual metabolization of hyaluronic acid fillers, more predictable results, less risk of complications, and no need for surgery are reasons why I lean towards facial filler treatment over facial fat transfer. I hope this helps you.
@@AmiyaPrasadMD :( wasted my money im just student needed volume to my face
Exuse me; does hylloronic acid really get metabolised, doesn't it migrate to other face parts with time causing a bloat look ?
Hi Arian Business,
The amount, and lighter viscosity of filler placed in the lower eyelid usually doesn't migrate. Filler migration is more likely using higher viscosity fillers in areas like the cheeks, as more filler material is used, and when placed at the fat or soft tissue level, they can't support the weight of the filler. I place cheek, and jawline filler at the foundational bone level, between the stronger muscle to hold it in place, and prevent migration. You can refer to this video about it - ruclips.net/video/Brb4uTzzG88/видео.html
I have a large dent in the middle of my forehead from an injury. Problem is, it’s in the Glabella area, the “danger zone” for fat grafting. What is my risk of blindness or problems in this area?
Hi Anders Franz,
The glabella area can be treated with filler. Risks of blindness are reduced by the experience and expertise of the doctor working in this area. I've been able to inject to this area without complications. I hope this helps you.
Amiya Prasad, M.D. Is filler safer than fat grafting? And which is a more permanent option?
Hi@@andersfranz5367,
Fillers are more convenient for you in this area as it involves no surgery. There are very few permanent solutions that are safe and predictable. I don't advise permanent fillers due to high risk of complications, especially in this area. Hyaluronic acid fillers are safely metabolized with body with time. Grafted fat is also gradually absorbed by the body, but holding shape can be less predictable as fat does require a blood supply, and can be lumpy after removed from its original blood supply. I hope this clarifies things for you.
Amiya Prasad, M.D. Ok thank you. How long do you think the filler would last?
Hi@@andersfranz5367,
Hyaluronic acid fillers for this area last about a year.
How about the new technique of nano fat microneedling? Would this work better?
Also, can hollows and volume loss appear after eye bag surgery?
Hi @dammar117,
Nanofat still behaves like fat - it needs a blood supply to survive, and once it is removed from its original blood supply, it needs to take to a new blood supply. When fat is removed from its original blood supply, its shape and texture change unpredictably, hence the lumpy texture.
Hollowness and volume loss can appear in the lower eyelids if too much fat is removed during eye bag surgery. The art of lower eyelid surgery is to leave a little fat behind for a continuous contour from the lower eyelid to the cheek, and to prevent a hollow appearance. This is largely dependent on the experience of the surgeon performing the procedure. I hope this clarifies things for you.
@@AmiyaPrasadMD There's an article (I can't paste a link here, but the title is "Nanofat in Plastic Reconstructive, Regenerative, and Aesthetic Surgery: A Review of Advancements in Face-Focused Applications") that says that "The Lipogem technology [...] enables the isolation of nanofat with an intact perivascular structure." I wonder if that makes a difference?
Hi@@dammar117,
While I do perform fat transfers in areas where the skin is thicker, I don't perform it under thin lower eyelid skin that is only 0.5mm thick because the irregularities of grafted fat like bumps can be seen through thin lower eyelid skin, as shown in the video. There are many doctors who perform this procedure, but they can't remove the grafted fat when complications occur, so their patients come to me as an oculoplastic surgeon to surgically remove it, so I know how prone to complications lower eyelid fat transfers are. I hope this clarifies things for you.
@@AmiyaPrasadMD Yes, thank you. Your response is very helpful.
You're welcome,@@dammar117