Today I would like to talk about “How to treat or prevent the grafted fat comes down to eyelids”. Sometimes fat injection you had previously comes down to near the upper eyelid area and make bulging on your upper eyelid look like:
As you can see from the picture there are fat has been come down. This patient had fat grafting from other clinic 5months ago and had side effects of fat has been coming down. This is not common but it can happen! we call that “Periorbital lipogranuloma after facial autologous fat injection”.
Recently Dr. Hong Dae, Kang from JW Plastic Surgery Center Korea who are specialist in Eyelid surgery, anti-aging, and fat grafting had speech to other overseas plastic surgeons at APS (Aesthetic Plastic Surgery) 2017 from COEX, Seoul, Korea on April 2nd.
Nowadays many plastic surgery centers do Fat grafting (fat injection) to volume restoration. Because it is easy to harvest, low morbidity, non-allergic compared to synthetic fillers. But sometimes there are some complications from fat grafting (fat injection) such as edema, lump, irregularity, migration, lipogranuloma, etc., So Dr. Hong Dae, Kang had speech about the Lipogranuloma.
Definition of Lipogranuloma is “Rare reactive inflammatory process in the dermis and subcutis” which it means injected fat could come down to the dermis area.
Why lipogranuloma happens?
We can split the reasons in two ways
1. Exogenous mechanism: Foreign body reaction to lipid / oil-like substances such as paraffin and silicones
2. Endogenous mechanism: Lipid degeneration due to infection, trauma, extremes of temperature, or allergic reaction
Upper / Lower eyelid is surrounded by superficial galea and deep galea (devided into anterior and posterior also covered with galea fat pad) and there are some kind of paths that it connects to each other.
That is why we should inject the fresh fat instead of frozen fats. There are many places that uses frozen fats for their second session but that will raise the rate of Lipogranuloma, because frozen fats will dissapear when fresh fats frozen under negative 20 degrees due to their intracellular ice formation and osmotic stress and loses of 92.7% of metabolic activity.
This patient had Fat grafting 5months ago from other clinic and had “periorbital lipogranuloma”
So Dr. Hong Dae Kang performed Lower eyelid mass excision and Lower Blepharoplasty at the same time. On the left part of lower eyelid seemed to have large lipogranuloma on the orbital fat, oom.
This above picture is the mass (fat tissues) that has been removed.
This picture POD 7 (7 days) after removal of upper eyelid lipogranuloma.
– No more sagginess above the eyelids
– More skin tightness
– Look younger
This operation has been done by Dr. Hong Dae Kang from JW Plastic Surgery Center who is specialist in Eyelid surgery and Anti-Aging