Periorbital Fat Grafting

Fat grafting to the eyelids and periorbit is a delicate and highly specialised surgical treatment to restore volume and improve on soft-tissue contours around the eye. The procedure addresses hollow and sunken eyes, under eye creases, periorbital dark circles, minor eye bags, thinning skin and pronounced tear troughs. In addition, placement of fat within the orbit can improve eyelid health for individuals with scarring, atrophy, lid retraction, ectropion, lagophthalmos and facial palsy.

Full, healthy and soft contours of the periorbit and eyelids gives an attractive and appealing appearance to both men and women and conveys a sense of youthfulness and vitality. Volume depletion and loss of fullness in the periorbit is one of the most obvious and earliest signs of facial ageing and usually one of the main objectives for patients seeking facial rejuvenation.

The causes of periorbital hollowness are most often congenital (of genetic origin), but may also be acquired (arising from trauma, disease or surgery). The fine and intricate tissue surrounding the eyes is also sensitive to environmental influences and will reflect physiological changes relating to general health, hydration, metabolism, hormonal status (females), as well as stress and lack of sleep.

The periorbital region spans the upper and lower orbital rim and transitions into the surrounding structures; including brows, temple and upper mid-face. The periorbital anatomy can be divided into two distinct parts, (1) a superficial area with facial fat (located above the orbital septum) and (2) a deep area with structural fat (below the orbital septum). These two regions have a different physiology, contain separate fat compartments and will age independently of each other.

At the Sorensen Clinic we provide highly specialised surgical treatments for periorbital atrophy, deflation and hollowness.

Volume loss - lower periorbit

The superficial area of the lower orbit is the first to lose volume, develop shadows, hollowness and creases. Patients often describe this as their "problematic under-eye area" which makes them appear tired.

Symptoms include thinner skin and a partial or generalised exposure of the lower orbital rim, either as a primary issue of atrophy, or caused by age-related descent of the soft-tissue in the upper-cheek (or a combination of both). The tear-trough and orbitomalar groove will often be visible, forming a V-shaped depression at the lid-cheek junction (known also as 'lower periorbital hollowing').

Volume loss will often expose minor asymmetries to the bone or deeper underlying tissues. A loss of structural support in the lower orbit may also be associated with herniation of the orbital fat, forming a bulge located above the lower orbital rim (eye bags).

If structural support is compromised in the under-eye area (i.e. due to changes in bone, ligaments and fat content), it can affect the position, shape and function of the lower eyelids.

Volume loss - upper periorbit

When analysing volume loss in the upper orbit, it is relevant to distinguish between superficial and deep hollowness. Superficial loss of volume occurs simultaneously with the surrounding facial fat compartments of the brow and temple and may include: skin laxity, rhytids, brow deflation, brow descent and upper eyelid hooding. More advanced superficial hollowing will cause a sunken temple and reveal the bony outline of the orbital rim.

The deep structural fat is more resistant to age-related deflation. Volume loss inside the orbit is often genetically determined and most patients indicate similar features in their parents or grand parents. Changes are initially more pronounced in the central-inner aspect of the orbital rim (sometimes referred to as an 'A-frame deformity'). In the case of more advanced hollowness, the entire eye socket will appear sunken, forming a 'deep superior sulcus' below the orbital rim.

Although superficial and deep volume loss may occur simultaneously, they represent two distinct medical conditions, which require a different treatment approach.

Periorbital rejuvenation

The multi-layered transfer of living fat cells to both the superficial and deep tissue compartments has a very high rejuvenative potential. It can significantly refresh the eyes and orbit and provide long-term improvement to both aesthetics and function.

Because there are wide variations in eyelid/periorbital anatomy among individuals, it is necessary to customise the volume restoration for each patient. During consultation, Dr Sorensen will examine the orbit and eyelids, measure facial proportions and discuss individual requirements and goals, in order to formulate an effective treatment plan.

Preventing volume loss

Treatment with autologous fat cells (patients own fat) is also effective in preventing ageing related to atrophy and volume loss in and around the periorbital region. By preserving natural youthful facial contours, there will be less likelihood for age-related changes which occur as a result of deflation (i.e. skin laxity and descent of soft-tissue).

At the Sorensen Clinic, we have observed many of our patients who have received conservative micro fat grafting treatments for more than 10+ years (performed at 2-3 yearly intervals). These individuals have maintained their fat content from the mid-thirties onwards and subsequent facial age-related changes has been kept to a minimum.

Highly specialised treatment

Treating the periorbital region differs from fat grafting performed elsewhere in the face, particularly when addressing the lower orbital rim or the deep hollowness within the eye socket. Due to the fine and delicate nature of the tissue, a conservative approach is essential to avoid contour irregularities.

Periorbital fat grafting may be performed as a stand-alone procedure or integrated with other facial and/or oculoplastic surgeries; including upper and lower blepharoplasty, endoscopic brow lift, facelift and treatment for facial asymmetry. The combination of periorbital fat grafting with other surgical procedures will enhance results and provide synergistic benefits.

It is important to note that certain ethnic groups, (i.e. of Asian and Middle-Eastern descent) have an inherent tendency for periorbital hyperpigmentation. Dark circles caused by pronounced skin pigmentation do not respond to fat grafting with regards to skin colour, but will achive benefits in regards of improved contours. A consultation with our skin specialist/aesthetic team is available as part of the treatment, to advise on the appropriate skin treatment options.