I am/was very motivated in getting this done this year to address hollowness and dark circles. I contacted 3 cosmetic surgeons who specialize in facial procedures including fat transfer and who have good reviews across several forums. Here's what came out of it.
Surgeon #1
Does facial fat grafting everywhere except under the eyes. Says the results are too unpredictable - the % of fat that will get vascularized and remain in place is unknown, can be about 80% down to about 20%. Because of that many patients require a 2nd procedure, and even with that many are still unhappy with the results. Also there is a significant risk of asymmetry when more fat takes hold on one side, and more fat is eliminated on the other. Lumps are also possible and cannot be simply dissolved with an enzyme injection like with fillers. Did not try to sell me fillers as an aletrnative.
Surgeon #2
Says pretty much the same as #1 and actively discouraged me from pursuing it.
Surgeon #3
Complete opposite from the other two. Done lots of it, piece of cake, easy peasy, you'll love it.
If board certified experts at the top of their game do not agree, how can I, a mere lay person, make the best decision?
I had made my homework before. Apparently there is a new device called BeautiFill that produces uniform predictable results where about 95% of the grafted fat survives. But even there experts do not agree. See here for instance. In any case none of the 3 clinics I contacted uses this device.
I briefly considered going to California to get the procedure done by one of those "star doctors" that have a YouTube channel. Not counting the travel expenses, the cost is about 4.5 to 5.5 times what I would pay locally. But the real show stopper was that there were 4 mandatory in-person follow up visits which is impossible for me as I am working.
Just a word about before/after pictures & videos: these are NOT representative of what one can reasonably expect. A surgeon may have done 2,000 procedures and selected his top 5 for his website or YT channel. These are best case scenarios, not average outcomes.
I don't know what to do at this point. Fillers also have their own set of issues. Any feedback is much appreciated.