Lower Eyelid Fat Repositioning: Why Combining It with 0000 Improves Results by 120%! Find Out

I am Dr. Im Seong-yun, a board-certified plastic surgeon with 21 years of experience.

Everyone! It feels like lower eyelid fat repositioning surgery has become a mainstream procedure these days.

Even people whose under-eyes are very normal and pretty come in for consultations.

That probably shows how much people want to avoid aging and look younger, right?

Under-eye aging is not only a matter of wrinkles,

nor is it something caused only by having too much fat.

In reality, structural aging is the key, with changes in the bone–fat–skin–ligament complex all happening together.

Based on my consistent experience,

the combination of lower eyelid fat repositioning + "fat grafting" is

what I believe takes the result to the next level,

so I’ll explain the principles and reasons behind it.

1️⃣ The real reason the under-eye area looks aged: “The structure changes”

As we age, the following changes happen at the same time.

Increased orbital space (the bone that holds the eye)

→ The bone supporting the eye recedes backward, creating more space.

deep fat decreases and shifts

→ The fat that served as cushioning decreases or changes position.

Thinning skin & reduced elasticity

→ Even very small hollows are emphasized like shadows.

Relative protrusion of lower eyelid fat (pseudo-herniation)

→ The bulging looks more pronounced, and the groove appears deeper.

In other words, simply addressing the protruding fat is not enough.

The emptied space must also be restored for a natural youthful look.

2️⃣ Why combine fat grafting with lower eyelid fat repositioning?

Lower eyelid fat repositioning relieves the groove by moving the protruding fat.

However, there are limits to how much it can fill the reduced deep fat

and the enlarged orbital space.

👉 This is where fat grafting plays an important role.

✓ Supplements reduced deep fat

✓ Naturally fills the enlarged orbital space

✓ Forms a cushioning layer under the skin → reduces fine wrinkles and shadows

Softens the connection between the under-eye area and the midface, improving the tired appearance

So when the two procedures are done together,

“A flatter under-eye area + natural volume + a softer impression”

→ The perceived result improves by 120%.

3️⃣ The key evidence from studies (2025 latest review & MRI research)

🔬 Periocular Aging & Tear Trough Prominence (2025) Recent academic reviews clearly point out the following.

The lower eyelid fat looks more prominent,

the tear trough is emphasized,

and as midface volume loss progresses,

→ it is perceived as giving an older and more tired impression.

👉 In other words, the conclusion is that there are limits if the under-eye area and midface are not considered together.

🧠 MRI-based periorbital aging study (analysis of 118 people)

In a study that quantitatively analyzed structural changes using MRI,

increased orbital volume,

increased/repositioned lower eyelid fat,

changes in bone structure and imbalance in soft tissue

were reported to lead to a more visually pronounced under-eye groove.

👉 In other words, if the structure is not filled in, the aged appearance remains.

4️⃣ Is fat grafting safe in terms of side effects?

This is the question I get most often during consultations.

Some clinics may even consider fat grafting with lower eyelid fat repositioning to be contraindicated.

To begin with the conclusion,

if a sterile environment + thorough hemostasis + small-volume, layered grafting are followed,

✔️ inflammation

✔️ calcification

✔️ hard nodules

The likelihood of side effects like these is

very low, and I personally have not yet had such an experience.

✅ Key points for minimizing side effects

✓ No excessive greed: do not inject too much at once.

✓ Distribute grafting by depth: do not let it clump in one layer.

✓ Under-eye-specific strategy: the under-eye area is approached differently from cheek grafting.

✓ Fat quality management: the refining and processing steps are important.

5️⃣ Under-eye aging is best treated by “structural treatment”

The under-eye area is not simply a cosmetic issue; it is the result of anatomical changes.

❌ Remove only the fat → may look flat but still aged

❌ Repeat filler only → unstable volume, long-term limitations

✅ Fat repositioning + fat grafting together

→ structural restoration + a natural youthful impression

The more fully you understand and approach under-eye aging,

the more clearly the results will differ.

Fat grafting performed together with lower eyelid fat repositioning can make the surgical result even better, and it also helps with the color of dark circles.

Today’s plastic surgery column,

JUST DO IT

This was Im Seong-yun.

Thank you.