Grace Plastic Surgery 40s Case: Improved Eye-Opening Strength After Upper Eyelid Fat Grafting

In this case, the patient’s comfort when opening the eyes improved with only 0.9 cc of grafting. It is not simply about filling the “hollow area” with volume; as the fat balance around the muscle that opens the eyes (the levator palpebrae superioris) improves, the strength of eye opening can also change.

Upper eyelid fat grafting is a procedure that restores volume by injecting one’s own purified fat into a hollow upper eyelid that looks sunken, causes the double eyelid line to overlap, or makes the eyes look tired. The goal of this procedure is not simply to “make it bulge,” but to restore balance in the soft tissues (muscle and fat layer) of the sunken area. The layer where fat is injected is very important. A simple injection method that places fat into the layer just beneath the skin (the orbicularis oculi muscle layer) has a low survival rate. At Grace Plastic Surgery, fat is grafted into the orbital fat layer, a deeper layer. The orbital fat layer is the deepest fat space in the eyelid structure and is located below the muscle layer, so the survival rate is high and fat resorption is stable. This area not only fills the “hollow,” but also reduces friction between the muscle that opens the eyes (the levator palpebrae superioris) and the fat layer, which can help ease the fatigue felt when opening the eyes.

• Grafted area: Fractional injection of 0.9 cc of orbital fat, centered on the sunken upper eyelid area

• Surgical purpose: Restore volume and relieve muscle tension

• Combined correction: None (standalone pure fat grafting)

Why Director Choi Moon-seop’s know-how is special: Upper eyelid fat grafting is not a simple “procedure,” but a microsurgical technique that requires anatomical understanding and a delicate sense of touch. Based on thousands of clinical cases, Director Choi Moon-seop uses a detailed technique that adjusts and grafts fat in increments of 0.1 cc. At Grace, a typical open-type cannula is not used. Instead, a self-manufactured micro-cannula with a special structure is used to directly access the orbital fat layer without damaging blood vessels or the muscle layer. This injection method is a confidential technique shared only internally and is not disclosed outside the Grace Plastic Surgery medical team. Upper eyelid fat grafting is not just a procedure that fills hollows; it is a delicate surgery that considers both the anatomy and function of the eyes. In particular, the technical skill of precisely injecting into the orbital fat layer and the confidential technique using a micro-cannula are the culmination of the know-how Director Choi Moon-seop at Grace has accumulated over many years.

Upper eyelid fat grafting is not simply a procedure to fill in hollowness caused by aging. Due to genetic factors or the structural characteristics of the eyelid, some people in their 20s may also have a sunken upper eyelid or an unstable double eyelid line. In particular, when there is insufficient fat above the eyes, the double eyelid line may not be defined consistently, or the eyes may look tired and sleepy because the strength of eye opening appears weak. In such cases, restoring the balance of the fat layer through upper eyelid fat grafting can make the double eyelid line clearer and relieve unnecessary tension in the muscle that opens the eyes, leading to a more natural and comfortable eye appearance. In people in their 30s and 40s and beyond, aging can thin the eyelid fat layer and reduce skin elasticity, causing the double eyelid line to overlap or making the area above the eyes look hollow. At this stage, it is often better to combine fat grafting with treatments that improve skin elasticity or lifting rather than performing fat grafting alone. At Grace Plastic Surgery, autologous fat is precisely grafted into the orbital fat layer to increase the survival rate of the fat, and through deep-layer injection rather than superficial injection, three-dimensional yet soft volume is created. Even over time, a natural curve can be maintained without clumping. Upper eyelid hollowness in people over 50 is often accompanied by a combination of fat loss, muscle weakness, and sagging due to gravity. In such cases, simply injecting fat is not enough; the movement of the muscles and skin tension must also be considered to achieve a more harmonious result. After precisely analyzing the thickness of the fat layer, muscle movement, and skin elasticity, which vary by age group, a micro-technique that adjusts and grafts fat in increments of 0.1 cc is applied. This delicate surgical approach can go beyond simple volume restoration and lead to relief of functional eye fatigue and even improvement in vision.

Upper eyelid fat grafting usually achieves sufficient results with a single grafting session, but if the fat survival rate is low or the hollowness is severe, a second supplemental graft can further stabilize the line. The important thing is not to inject a large amount, but to place the fat accurately at the proper location and depth to create a result that takes the anatomical structure of the eye into account.

At Grace Plastic Surgery, fat is grafted into the orbital fat layer (deep layer) rather than the typical orbicularis oculi muscle layer (superficial layer) to maximize survival and naturalness. For this, a self-developed cannula is used, and this equipment is maintained as the hospital’s own know-how that is not disclosed externally. The shape of the cannula and the injection angle are adjusted based on data accumulated through many years of clinical experience. Upper eyelid fat grafting at Grace Plastic Surgery, created by combining this technical skill and experience, can be described as a medical approach that restores not only hollowness but also the structure and function of the eyes. Through autologous fat, the upper eyelid volume is restored with a texture most similar to one’s own tissue, and through orbital-layer grafting with a high survival rate, a natural eye appearance that does not change over time can be maintained. In the end, what matters is not the amount of fat but the “location” and the “layer,” which comes from technical skill based on years of experience and anatomical understanding. Grace Plastic Surgery’s upper eyelid fat grafting is a precise procedure that accurately diagnoses the cause and structure of hollowness regardless of age and creates the most natural-looking eyes.

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