Under-Eye Fat Repositioning Surgery Method? Do It This Way and Worries About Recurrence Disappear.

Hello, this is Dr. Shin Jong-in, director of Obje Plastic Surgery.

In February, which should have been getting warmer, a cold wave continued and there were even heavy snowfalls, so there were days when I thought it would be difficult for people who had already booked consultations to come in. But most of the patients still came in for consultations and even scheduled their surgery dates.

When I asked how they made it through the snow, they said, “I’ve been waiting for the day I could consult with you, doctor. What’s the problem with this kind of weather?” ^^;

The patient who came through the snowy road was worried about bulging under-eye fat and came in considering under-eye fat repositioning. After examining them, I said they would likely get very good results from under-eye fat repositioning and recommended surgery, after which they went home having scheduled the procedure.

I do a lot of consultations and surgeries for under-eye fat repositioning. I’m always grateful that so many patients specifically seek me out.

I think the reason so many people come to me is because, since opening my practice, I have spent nearly 20 years researching and working toward a better method for under-eye fat repositioning surgery^^.

Today, I’d like to take the time to explain in detail, step by step, the under-eye fat repositioning surgery method that so many people come looking for.

A Under-Eye Fat Repositioning Surgery Method Established Through 20 Years of Research? Beneath the human eyes is fat that serves as a cushion to protect the eyeballs, and this fat is contained within the orbital septum attached to the bones surrounding the eyes.

It may be easier to understand the orbital septum as a pouch that holds the fat. At first, this fat pouch is firmly attached, but as time passes it gradually sags. At that point, the part attached to the bones around the eyes keeps the pouch shape, while the upper part bulges forward like a balloon inflating.

This is what appears on the skin surface as bulging fat under the eyes. Because the sagging fat loses elasticity and looks protruded, the lower part of the under-eye area looks relatively hollow, creating a tear trough.

The surgery that improves this is under-eye fat repositioning. At Obje Plastic Surgery, we apply a somewhat special under-eye fat repositioning surgery method: we perform two approaches together, called Reposition and Reset.

Reposition means exactly what it sounds like: putting something back in place by changing the location of the fat. The bulging fat is moved to a hollow area in a way that matches the under-eye structure, filling in the hollow tear trough.

However, Reposition involves making an opening in the orbital septum to move the under-eye fat, and when only Reposition is performed, the support structure of the under-eye fat tends to weaken. To compensate for this, we also apply Reset.

Reset means resetting the setting, or restoring the condition of the orbital septum. It is a method of tightening the loosened orbital septum so that the protruding fat is pushed back inward.

Reset helps increase the support of the under-eye fat pouch, which greatly helps improve the longevity of the surgical result.

At first, I tried Reposition alone, and later I also performed Reset together with it, conducting various studies to determine which approach was better. Currently, I use an under-eye fat repositioning method called “dual fixation fat repositioning,” which applies the advantages of both methods at the same time.

Dual fixation fat repositioning, available only at Obje Plastic Surgery, repositions the fat while improving the elasticity of the orbital septum, making it a surgical method that helps prevent the fat from bulging out again and allows the result to last for a long time.

Any surgery comes about after medical professionals think deeply for a long time and put a great deal of effort into improving it with better methods.

The dual fixation fat repositioning method that I perform is no different. It was not created all at once; rather, over many years, I tried various methods and gradually improved it while sending data to plastic surgery journals and overseas papers for verification.

Thanks to that, I have now settled on the dual fixation fat repositioning method. Based on the techniques developed through research over the years, Obje Plastic Surgery performs surgery flexibly according to each patient’s different eye shape.

I may be cautiously saying that dual fixation fat repositioning is a highly advanced under-eye fat repositioning surgery method, and personally, I take pride in the excellence of the surgical technique.

Obje’s 7-Step Know-How for Dual Fixation Under-Eye Fat Repositioning

Step 1: Conjunctival incision vs. skin incision

In under-eye fat repositioning, the first important point is where the incision is made. For under-eye surgery, I use two methods: skin incision and conjunctival incision.

A skin incision is made just below the eyelashes and is often performed for people whose skin has sagged somewhat due to aging.

A conjunctival incision is made through the mucosa on the back side of the eyelid, cutting the invisible conjunctiva. This method is suitable for younger patients.

The method above is generally called lower blepharoplasty, while the method below is called fat repositioning.

Step 2: Under-eye fat removal vs. under-eye fat repositioning

Traditional under-eye fat surgery focused only on solving the problem of bulging fat beneath the eyes. As a result, under-eye fat removal was mainly performed.

However, simply removing the under-eye fat made it difficult to improve the deep tear trough. In the process of addressing this problem, the idea arose: “If this fat is going to be removed anyway, why not reposition it to flatten the eye area?” That is how under-eye fat repositioning was born.

I, too, have been conducting in-depth research on under-eye fat repositioning and performing surgeries for nearly 20 years. (Of course, even now I continue to present at academic conferences based on research into various cases. ^^) Even after such a long time of research and surgery, one thing I still consider important is improving the deep tear trough through under-eye fat repositioning.

When I reposition under-eye fat, I cut the tear trough ligament, called “TTL,” to relieve adhesion in the deepened tear trough. Only when the fat is accurately repositioned into the area where the adhesion has been released can a good result be obtained. Through this, patients are experiencing more effective under-eye fat repositioning results.

Step 3: In front of the orbital septum vs. behind the orbital septum

To reposition under-eye fat, the orbital septum—the fat pouch holding the under-eye fat—must be addressed. At this point, one must choose whether to approach it from in front of the orbital septum or from behind it. If the septum is approached from behind, damage can occur to the orbital septum itself and fat can leak out, making the surgery more difficult.

Therefore, approaching from the front of the orbital septum, rather than from behind, avoids damage to the septum and prevents fat leakage, allowing for a more effective surgery. That is why I perform the surgery by entering from the front of the orbital septum.

Step 4: The fixation location of the under-eye fat

When performing under-eye fat repositioning, it is important to reposition the fat, but for surgery that does not recur, the process of fixing the under-eye fat is even more important.

I reduce the possibility of recurrence by fixing the fat to the bone beneath the eye. However, because it is difficult to fix directly to bone, I attach the under-eye fat to the periosteum, the hard membrane surrounding the bone.

From my nearly 20 years of surgical experience, I have found that it is important to approach and fix beneath the periosteum so that recurrence is low and the result can last a long time. When fixation is done under the periosteum, the orbital septum holding the under-eye fat is kept elastic, and the recurrence of fat protrusion is minimized, which is why I consistently use subperiosteal fixation.

Step 5: Dual fixation fat repositioning

Step 5 is the dual fixation fat repositioning that uses Reposition and Reset together, as explained above. The bulging, distorted fat is repositioned, and the orbital septum surrounding the fat is also moved and firmly fixed.

By performing both Reposition and Reset, the deep tear trough can be improved while the effect lasts longer, so you can think of it as a method that takes advantage of both approaches.

Step 6: Septal reinforcement

In Step 5, when performing dual fixation fat repositioning, support is increased through Reset, and the method used at this stage is septal reinforcement. To perform septal reinforcement, one must find and use the reinforced septum, which is made of tougher tissue among the septa surrounding the under-eye fat. The weaker parts of the septum have less support, so even if septal reinforcement is performed, recurrence is more likely.

Step 7: Fixation work

The last step is fixing the thread used in the surgery. There are two methods: bringing the thread out and securing it externally, or securing it internally so the thread is not visible.

Using the external method is easy, but the drawback is that the needle marks remain for a long time. Recently, special suturing needles have been introduced to address this, but the number of sutures is limited. ^^;

Fixing the thread internally requires checking many points and proceeding delicately, so compared with the method of bringing the thread out, it is more cumbersome and tends to take more time.

Still, when the thread is fixed internally, it holds the tissue for a long time and gives enough time to secure support, so even though it is cumbersome, I continue to use this method. Patients also feel very satisfied because there is no need to remove stitches.

Even though it takes longer and the technique is more difficult, the fact that it provides patient satisfaction and long-lasting results makes the internal fixation method feel more comfortable to me.

Also, because I verify all the fixation points in the tissue before suturing, it allows for a neat finish, which is another advantage. ^^ When you look at the steps of the under-eye fat repositioning surgery method I explained, you may think, “There are more manual steps than I expected.” As I often say on YouTube, under-eye fat repositioning is not as simple a surgery as people may think, so the role of the operating medical team is very important.

It is not just a matter of removing and repositioning the bulging under-eye fat. One must consider how to reposition the fat, how to restore the elasticity of the orbital septum, and how to carefully suture the thread internally... There are many things to pay attention to.

Doing a good job of repositioning the under-eye fat is important, but to prevent recurrence, it is essential to properly fix the under-eye fat and orbital septum. As a result, there are more points to consider during surgery than people might expect. That is why the surgeon’s technique and clinical experience are so important in under-eye fat repositioning.

The eyes are a part of the face that people see immediately, so they have a major impact on one’s impression. Because of that, while it is important to remove the bulging under-eye fat through repositioning, it is also important from an aesthetic standpoint how much improvement was achieved.

For most patients, under-eye concerns are greatly improved with under-eye fat repositioning alone. However, in cases where the under-eye area is significantly hollow, it can be difficult to achieve better-than-expected results with fat repositioning alone. For such patients, I sometimes recommend “single fat cell grafting” together with the procedure.

Single fat cell grafting is my own special under-eye procedure that adds volume to hollow under-eyes and makes them look younger. I will explain this in more detail in a future post.

I think I became more eager to explain it than I intended, because this post turned out much longer than I expected. As I always emphasize, for any cosmetic surgery, I believe the top priority is whether there has been enough understanding of the procedure through consultation with the medical professional.

I plan to keep writing posts that can be helpful going forward. I would appreciate your understanding even if I come a little slowly.

This has been Dr. Shin Jong-in of Obje Plastic Surgery.

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• This post is medical information written by Obje Plastic Surgery Clinic in compliance with the Medical Advertisement Act.

• Results may vary depending on the individual, and side effects may occur.

We strongly recommend having sufficient consultation with the medical team in advance before deciding on any procedure.