The Management of Lumps, Bumps and Contour Irregularities of the Lower Eyelid and Cheek After Poor Outcome Fat Transfer.

The increasing popularity of fat transfer (FT) to the lower eyelids has led to an increase in unwanted lumps, bumps and contour irregularities (LBCs). Few studies have addressed the management of LBCs.To address the management of LBCs.In this retrospective review, charts of all patients presenting for evaluation of LBCs following FT procedures to the lower eyelid were reviewed. Clinical characteristics on presentation, and surgical findings were evaluated. Patient postoperative clinical course and complications were also documented.Forty-eight patients were included (45 women and 3 men), with an average follow-up of 14 months (range: 5-24 months). In 65%, LBCs manifested above the lower orbital rim (AR) and in 35% they were noted AR and below the rim (BR). The type of contour deficits noted were a solitary nodule (SN) in 54%, a Mixed picture (MP) in 23%, diffuse enlargement (DE) in 17%, and multiple nodules (MN) in 6%. Combining lesion location and type of contour deficit, the most common presentation was a SN-AR in 22 patients (46%), followed by a MP-AR/BR in 8 patients (17%), and DE- AR/BR in 5 patients (10%). Surgical findings revealed that grafted fat is consistently found separate from native eyelid/orbital fat, and within the orbicularis muscle when AR, and within the orbicularis muscle or the deep SOOF when below the inferior orbital rim.LBCs tend to manifest in characteristic patterns with a predilection for an AR location. We provide recommendations on the diagnosis and management of these lesions.