Aging of the face causes a descent of the thinning orbicularis muscle that surrounds our eye, as well as protect it. Next to that there occurs a descent of the cheek´s fat compartments, further accentuating the already more exposed lower bony border of our eye socket (orbit). To make matters worse, above this bony border, there is often fat herniation from orbital fat into the eyelid causing the typical eyelids bags and tired appearance.

Over the last years the way to address these changes has shifted from an open approach where the surgeon makes an incision below the total length of the eyelashes to excise skin and fat, to a transconjunctival approach, where an incision through the inside of the eyelid is made. This is also dr. van der Veen´s preferred approach. As such, we gain direct access to these herniated fat compartments and can partly excise them or transpose these fat pockets over the lower bony border to further smoothen eyelid cheek transition (see Lower Blepharoplasty). However, this is not always sufficient to smoothen the eyelid-cheek junction completely, moreover it does not change the other aging features of the face. This is where autologous fat transfer, or lipofilling, comes in.

How does Lipofilling work?

Through a small incision in the thigh or belly, fat is harvested from the patient with a mini liposuction. After being treated and cleaned, this fat can be transferred to the facial structures that lack volume. One of the most common locations of fat transfer is the above mentioned lower bony border of the eye socket, to smoothen the eyelid cheek junction. In the same session, the already harvested fat can also be used to treat other areas like the cheek, temple or eyebrows. The improvements made as such are natural, long lasting and completely biocompatible with your own body. When facial lipofilling is combined with blepharoplasty surgery and/ or ptosis correction, the overall facial rejuvenation, can be very powerful.

What are the pros and cons of lipofilling? 

The biggest advantage lipofilling is that it uses your bodies own fat, and for that reason it is 100% biocompatible. For that reason rejection or encapsulation of the injected fat rarely if ever happens. Another advantage is that there is always sufficient fat present to harvest to adequately address the hollows of the midface and upper third of the face. And, when injecting more substantial amounts, you do not run the risk of causing a Tyndall effect (blue hue under the skin) as you do with hyaluronic acid (HA) fillers.


This being sad, injection should be practiced judiciously and with in depth knowledge of the facial anatomy. Another mayor advantage of using fat over fillers (i.e. HA) is that it offers a very long lasting, or permanent, effect. There is some atrophy or reabsorption of the injected fat, for which reason often we overcorrect slightly and the patient can notice their face slightly more full in the early post operative period. This is done intentionally to compensate for the expected reabsorption in the first few weeks, and subsides thereafter.

A posible disadvantage of using fat to fill the under eye hollows or other facial areas, is that it can cause contour irregularities and slight lumps or bumps under the skin. These can be addressed, but is not always an ´easy fix´. If an area gets overfilled there is no quick solution as for instance using hyaluronidase after an AH filler injection.  



Bearing in mind these advantages and disadvantages, in our practice lipofilling proves to be an invaluable addition to blepharoplasty surgery or even as a stand alone procedure, with superior treatment of deep tear throughs, under eye hollows, deep superior sulcus, lack of volume in the cheek, cheekbone or temple.