For some patients a lower lid blepharoplasty can be combined with fat injections or microfat injections to the cheeks or mid face where there is hollowing in order to further enhance the outcome. Fat injections alone can be undertaken for some patients who have hollowing of the cheeks, eyelids, temples and other areas of the face. In this procedure, fat is removed from the outer aspect of the flank, buttock or thigh via a very small skin stab incision using very light finger suction with a syringe and blunt cannula to avoid damaging the fat. This can be done under “twilight anaesthesia” or, if preferred, under general anaesthesia.
For some patients with hollowing of the eyelids, either following cosmetic eyelid surgery with fat removal undertaken elsewhere, or as a consequence of age or a medical disorder, fat pearl grafting can be undertaken. In this an incision is made in the upper lid skin crease or on the inside of the lower eyelid (a transconjunctival incision) and fat taken from the abdomen or buttock via a small skin incision is divided into tiny pearls and placed directly into the area of hollowing of the eyelids.
For fat injections a single small “stab” incision is required in the skin and this is closed with a single stitch. The fat is then injected into a special closed filtration bag and washed with Hartmann’s solution, separating the fat cells from blood and local anaesthetic solution. The fat cells are then transferred to 1 ml syringes. The fat is then injected into the cheek/outer eyelid-cheek junction via a small “stab” incision with a sterile needle in tiny quantities. Several passes of a special small blunt tipped cannula are made to ensure an even distribution of the fat and the best chance of the fat gaining a blood supply in the facial tissues and thereby surviving. There is nevertheless a risk of up to 10% that the fat will not survive this process. The risk of failure is higher in smokers and therefore best avoided in this group of patients. The survival rate of the fat also falls in patients over the age of 60. The procedure can be repeated but the fat has to be harvested again as it cannot be stored. (Stored fat does not survive). This is a surgical technique that is commonly used for reconstructive surgery as well as for cosmetic surgery.
Such fat injections can be used to fill out hollow temples. It can also be used to enhance the effects of cosmetic eyelid surgery. The injected fat contains stem cells which are also known to improve the quality of the overlying skin, particularly in the cheeks.
Please note that although cosmetic blepharoplasty can be performed under local anaesthesia alone, local anaesthesia with safe, conscious intravenous sedation given by a very experienced and skilled consultant anaesthetist (commonly referred to as “twilight anaesthesia”) is also available where requested. This form of anaesthesia is extremely popular with our patients and the effects are reversed very quickly. It enables local anaesthetic injections to be given painlessly with little recollection of the surgery, and helps to keep patients calm, relaxed and comfortable. It also helps to prevent rises in blood pressure thereby minimizing bleeding and postoperative bruising.
Click here to listen to Dr Paul Lancaster talking to a patient about twilight anaesthesia at the Face & Eye Clinic. Dr Lancaster is an expert consultant anaesthetist at Manchester Royal Infirmary.
The very remote risk of blindness or stroke from fat injections must always be considered. It is for this reason that injections are given meticulously using special blunt-tipped cannulas and the higher risk area of the face (the glabella and root of the nose) is always avoided in our practice. We have undertaken fat injections with an excellent safety track records for well over 15 years.
Any patients requiring general anaesthesia or who are unsuitable for surgery at our day case facility, the Face & Eye Clinic, will be treated by our surgeons in a local private hospital e.g. Spire Manchester Hospital.