Blepharoplasty with Facial Fat Grafting in Valencia

In short

Tired-looking eyes are rarely just an excess: there is usually one area that bulges and another that is empty, and treating only the first can leave the face more hollow.
The fat is taken from the patient by a very small liposuction —the abdomen or the inner thigh— and placed during the same operation, not in a separate session.
The evidence available on fat grafting in the eyelid region is substantial: 4,046 cases reviewed, with satisfaction of 90.9% and an overall complication rate of 7.9% —6.1% in aesthetic indications—, mostly mild and temporary.
The commonest side effects are swelling, chemosis and contour irregularities; the first two resolve on their own as the tissue settles.
Fat placed under direct vision during surgery is not the same scenario as a blind injection in a consulting room, which is where the serious vascular complications described in the literature are concentrated.
It is not everybody’s operation. In a young eyelid, with a bag and good fullness, blepharoplasty on its own is enough.

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There is a very widespread idea about tired-looking eyes: that the problem is that there is too much of something. Too much skin on the upper eyelid, too much bag on the lower one, and the solution would be to remove it. That reading works in many cases and it is what a classic blepharoplasty rests on.

But in a good many faces —particularly from a certain age— the problem is not only one of excess. It is excess in one place and emptiness right beside it. The bag bulges because the fullness that used to disguise it has been lost underneath; the groove under the eye shows because the cheekbone has dropped and left a step. In those faces, removing without replacing improves one part of the problem and can accentuate the other: the eyelid is left smooth and the dark circle more hollow.

Hence this operation. The excess is removed and, in the same procedure, volume is restored with the patient’s own fat in the tear trough, the dark circle and the cheekbone. They are not two treatments that happen to coincide in the diary: it is one operation conceived as a redistribution of volume.

Why removing is not always enough

A lower eyelid has, from top to bottom, three things that can go wrong at the same time: a bag of fat pushing forward, a ligament that tethers the skin and creates the groove, and a cheekbone that loses height and projection over the years. The bag shows because there is a step below it; if there were none, the same bag would go unnoticed.

When only the bag is removed, the step is still there. The result can be a flatter eyelid but a dark circle just as marked, and in some cases more obvious, because there is no longer anything to soften it from above. It is the reason some people say, after a technically correct blepharoplasty, that they look “more rested but more drawn”.

Correcting that step is the aim of fat transfer. It is not a matter of filling the face, but of giving a specific volume back to a specific point so that the eyelid and the cheek read once again as a continuous surface.

In practice there are two ways of achieving it, and they are not mutually exclusive:

Repositioning the bag itself. Instead of removing it whole, it is released and moved downwards so that it fills the groove. What is already there is put to use.
Grafting fat taken from elsewhere. When the bag does not go far enough, or when the cheekbone also has to be restored, fat is taken from the abdomen or the inner thigh and placed in small amounts.

A series of 339 lower blepharoplasties, with almost thirteen months of mean follow-up, compared the two strategies against the tear trough. Both resolved it, with single-digit revision rates. What matters is not which won, but what both share: the aim is no longer to empty the eyelid, it is to fill the step.

lower blepharoplasty in valencia

Side-view cross-section of the lower eyelid with the bag of fat shaded in orange and the tear trough and the cheekbone in purple, next to each other — The bag shows because there is a step just below it. Removing it without filling the hollow improves half the problem and can leave the other half more marked: hence the surgery is planned as a redistribution of volume and not merely as a removal.

What exactly is done in this operation

The operation combines a full blepharoplasty —upper and lower eyelid— with taking and placing the patient’s own fat. In order:

Marking standing up and with the eye open. The excess skin of the upper eyelid and the position of the groove cannot be marked with the patient lying down.
Upper eyelid. The excess skin and a measured strip of orbicularis muscle are removed, which is what stops the eyelid bulging and gives the crease definition. The medial fat is removed conservatively; the central fat is left alone.
Lower eyelid. The route is decided by one thing alone: whether there is excess skin or not. If there is, the surgeon goes in below the lashes —the percutaneous route—, which is the only one that allows it to be removed. If there is not, the surgeon goes in from the inside —transconjunctival— and there is no external scar. Each pocket of fat is identified and it is decided whether it is removed, repositioned or both.
Taking the fat. A very small liposuction, of a few millilitres. The patient chooses the area; the usual choices are the abdomen or the thighs. It leaves an incision measured in millimetres.
Concentrating and placing it. The fat is concentrated —by decanting, centrifuging or filtering, depending on the case— and placed in small amounts and in several planes, in the tear trough, the dark circle and the cheekbone, under direct vision as the field is already open.
Closure. In the upper eyelid, inside the natural crease. In the lower one, according to the route chosen.

upper blepharoplasty in valencia transconjunctival blepharoplasty in valencia

A two-panel comparison: repositioning the bag of fat itself towards the groove against grafting small deposits of fat — The two routes are after the same thing. When the bag itself goes far enough, it is moved so that it fills the groove; when it does not reach, or when the cheekbone also has to be restored, fat is grafted in small amounts. In a series of 339 lower blepharoplasties both resolved the groove with single-digit revision rates.

Why in the same procedure and not in two stages

It is a reasonable question: if they are two things, why not do them separately?

Because the volume is decided by seeing the hollow for real. With the field open you can see exactly where filling is missing and how much. Working it out from outside, through closed, swollen skin, is far less precise.
Because it is one anaesthetic and one recovery. The swelling and the bruising of the two overlap instead of adding up in two rounds.
Because the result is judged as a whole. A blepharoplasty assessed at three months and then touched up with filler means deciding twice, and the second time with the result already settled and the reference point lost.
Because the fat is placed under direct vision, with the tissue in view, and not blind through the skin.

That last point deserves a section of its own, because it causes the most confusion.

Fat in theatre versus filler in the consulting room

The literature describes serious vascular complications —including loss of vision— after fat injection in the face. It is a real risk and it is worth looking at precisely, not from a distance.

A systematic review bringing together 34 pieces of work on ophthalmic complications after facial fat injection found that the area most often involved was the forehead, in more than half the cases, and that occlusion of the ophthalmic artery accounted for around half the complications described. With treatment, 80.6% of patients recovered completely.

The important thing for understanding this page: that scenario corresponds to blind injections through the skin, pushing product into areas of high vascular density. It is not the situation of fat placed during surgery, with the field open, seeing the plane it is deposited in and with no injection pressure on a vessel you cannot see.

That does not mean surgery is harmless —none is— but that they are two different scenarios and should not be mixed up when weighing the risk. Any professional offering filler around the eye should be able to explain that difference.

What the evidence says about fat grafting in the eyelids

It is a technique with more backing than is usually supposed. A systematic review with meta-analysis brought together 39 studies and 4,046 cases of fat grafting in the eyelids and the periorbital region:

Satisfaction of 90.9% (95% confidence interval: 86.4-94.0). In aesthetic indications, 91.6%.
Complications in 7.9% of the total and in 6.1% of the aesthetic cases. The figure rises to 23% in reconstructive indications, which are cases of another kind.
The commonest: swelling, chemosis —swelling of the conjunctiva, that watery look of the white of the eye— and contour irregularities. The authors point out that most of them were mild and self-limiting.

Chemosis is worth dwelling on, because it is alarming when it appears and it is one of those that go away on their own. The same is true of the dryness some patients notice in the first few weeks: it is common, it is temporary and it settles as the eyelid beds in.

Contour irregularity is the one that can require a touch-up, and it has to do with the amount placed. It is the technical argument for being conservative: it is easier to add on a second occasion than to take an excess away.

combined blepharoplasty in valencia

How much of the fat stays

It is the question with the least tidy answer, and it is best put that way. Part of the grafted fat does not integrate and is reabsorbed in the first few months; how much varies from one person to another and there is no reliable figure that holds for every case or for every area of the face.

Two practical consequences follow from that variability:

The final result is not judged before three to six months. Before that, what you see is a mixture of grafted fat and swelling.
Sometimes a second small top-up is proposed. It is not a failure of the first operation: it is the sensible way of adjusting a tissue whose behaviour cannot be predicted completely.

Anyone promising an exact percentage of fat survival is promising something the literature does not support.

Recovery

First 48-72 hours: swelling and bruising, which is when they are most noticeable. Local cold and sleeping with the head raised.
First week: the upper eyelid stitches come out. Most patients go back to their usual activity at around 7-10 days, with make-up if they wish.
First month: the bulk of the swelling goes. The grafted area still looks somewhat fuller than it will end up.
Three to six months: the volume settles and the result can genuinely be assessed.

The area the fat was taken from gives less trouble than expected: as it is only a few millilitres, the discomfort is comparable to that of a bruise and it settles in a few days.

preoperative process in blepharoplasty

Risks and limits

In addition to those of any blepharoplasty:

Irregularity or asymmetry of the grafted volume. It is the aesthetic complication most characteristic of this technique and the reason for placing little and in several planes.
Temporary chemosis and dry eye. Common, uncomfortable and self-resolving.
Uneven reabsorption, which may require a later adjustment.
Cysts or small nodules in the grafted area, uncommon.
Complications at the donor site: bruising or irregularity, uncommon with such small volumes.

And a limit worth stating up front: this operation does not replace a facelift. If what there is is drooping of the cheek, restoring volume in the groove improves the transition but lifts nothing. They are two different problems and sometimes they coincide in the same face.

facelift valencia

Who is a good candidate

It fits particularly well when several of these conditions apply:

The dark circle shows even when the eyelid is settled, and not only because of the bag.
There is a visible step between the lower eyelid and the cheek.
The cheekbone has lost projection and the face looks flatter than it did a few years ago.
Fillers have already been tried and the result was uneven or short-lived.
The eyelid is going to be operated on anyway and you want everything resolved in one procedure.

And it does not fit —or is not needed— when the eyelid is young, the bag is the only problem and the fullness of the area is still good. In that case, blepharoplasty on its own is the cleanest answer, and that is what is said in consultation.

what blepharoplasty is and when it is indicated types of blepharoplasty

Price

The full operation —upper and lower blepharoplasty plus taking and placing the fat— is between €4,500 and €5,900. The range depends on what each case includes: whether one eyelid or both are operated on, how much fat has to be restored and which areas are treated.

The exact figure is settled at the prior assessment, in writing and before anything is decided.

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Frequently asked questions

Is it the same as having filler in the dark circle?

No. The material is different —your own fat against a product— and, above all, the moment and the route are: here it is placed during surgery and under direct vision, not by an injection through the skin in a consulting room.

Can people tell I have had fat put in?

The aim is precisely the opposite: for the transition between eyelid and cheek to stop showing. When it does show, it is usually from having placed too much, and that is why the rule is to be conservative.

Where is the fat taken from?

From wherever the patient prefers; the usual choices are the abdomen or the thighs. It is taken with a very small liposuction and the incision is a few millimetres.

How much does it cost?

Between €4,500 and €5,900, depending on what the operation includes in each case. The prior assessment settles the figure.

How long does the result last?

The fat that integrates behaves like the rest of the tissue of the face: it stays, and it ages with it. What cannot be predicted exactly is what proportion integrates.

Can it be done on the lower eyelid alone?

Yes. The full combination —upper and lower— is considered when both eyelids justify it, not as a matter of course. The lower eyelid and the upper each have a page of their own.

Does the bag come back?

The fat that is removed does not form again. What does carry on is the ageing of the rest of the area, which is a different matter.

And if I do not want a scar on the lower eyelid?

It depends on whether there is excess skin. When there is none, the surgeon goes in from the inside and there is no external scar: it is the transconjunctival route.

Sources

Yang F, Ji Z, Peng L, et al. Efficacy, safety and complications of autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis. PLoS One. 2021;16(4):e0248505. PMID 33793573 — 39 studies and 4,046 cases: satisfaction of 90.9% and complications of 7.9% (6.1% in aesthetic indications), mostly mild and self-limiting.
Mortada H, Seraj H, Alhamoud MA, Alghoribi RS, Alsuhaibani OS, Khoshhal MS, Neel OF. Ophthalmic Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2022;46(6):3013-3035. PMID 35650299 — 34 pieces of work reviewed: the forehead was the injection site most often involved and occlusion of the ophthalmic artery accounted for 50.4% of the complications; complete recovery in 80.6%.
Hedén P, Fischer S. Comparison of Fat Repositioning Versus Onlay Segmental Fat Grafting in Lower Blepharoplasty. Aesthet Surg J. 2021;41(7):NP717-NP727. PMID 33595637 — 339 lower blepharoplasties with a mean follow-up of 12.9 months: both strategies resolved the tear trough with single-digit revision rates.

Sources checked one by one against PubMed on 10-08-2026.

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If your eyelids have been looking tired and you do not know whether yours is a case for removing, restoring or both, that is exactly what is determined at an assessment in person: the eyelid is examined at rest and on opening, the volume of the area is assessed and what applies in your case is explained.