Properly Diluted Fat (PDF): An Easy and Safe Approach to Periocular Fat Grafting

Abstract

Abstract Background The main challenge of periocular fat grafting is the risk of contour irregularities, especially in the lower eyelid. Injection of diluted fat can decrease the likelihood of poor contour. Objectives The authors developed a simple method of periocular fat grafting in which the fat was harvested through unconventional cannulas and diluted before the injection to avoid the risk of contour irregularities. Methods A retrospective study was conducted on 200 patients who underwent fat grafting to the periocular region. Lipoaspirate was obtained through a 0.5-mm multiple-hole cannula and then was centrifuged. A solution of 70% fat was prepared (ie, properly diluted fat [PDF]) with saline and infranatant fluid as the diluent. The recipient site was tunnelized with a 1.2-mm cannula, and PDF was transferred utilizing a 1.2-mm cannula containing a single 1-mm hole. Aesthetic improvement was ascertained from pre- and postoperative photographs evaluated by 3 examiners. Results A total of 164 (82%) patients received follow-up 6 months postoperatively, and 83 of these patients (41.5%) returned for monitoring 1 year postoperatively. Nearly all patients had improvement in periocular contour, but variable loss of volume was observed by 1 year. Patients who presented initially with scleral show often had noticeable improvement. At 1 year, only 3 patients experienced contour irregularities comprising soft bulges, similar to fat hernias. Two patients showed fat accumulation after substantial weight gain later than 1 year postoperatively. Conclusions Preparation and periocular delivery of PDF by the described techniques yield good contour with a low risk of visible masses occurrence. Level of Evidence: 4