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Dark Circle Information

Causes of Treatment Failure

Cause 1 of under-eye dark circle treatment failure.

When treating with a laser

There are many types of medical lasers.

Lasers that can be used for dark circles include carbon dioxide resurfacing lasers, erbium-YAG resurfacing lasers, excimer lasers, Nd:YAG lasers, and Alexandrite lasers.

Effectiveness of resurfacing lasers

Resurfacing means lightly shaving off the skin. Using a laser for resurfacing can shave off the superficial layers of the epidermis or dermis and remove thinly distributed blemishes or age spots.

It is effective for localized blemishes or age spots, but in most cases it has little effect on treating the overall dark circles under the eyes.

Effectiveness of pigment lasers

Pigment lasers are mainly lasers that destroy red capillaries, and they can be used for capillary dilation within the skin layer.

They have little effect on the red muscle layer beneath the skin or on the vascular network that forms the muscle layer.

Therefore, dark circles cannot be treated with pigment lasers; they are lasers that only partially remove red capillaries within the skin layer.

However, removing a few skin capillaries does not make dark circles disappear.

The fundamental cause is the red muscle layer projected through thin skin, so the color of this muscle layer needs to be changed. No matter how much laser is used, the red muscle layer does not turn flesh-colored.

Therefore, if dark red circles are caused by thin skin, they are almost impossible to treat with lasers.

Cause 2 of under-eye dark circle treatment failure.

When correcting with fillers

Fillers such as Restylane, Artecoll, and Aquamid should not be injected indiscriminately under the eyes.

Fillers are not made for contouring.

They are simply for correcting fine wrinkles and small depressed scars.

There are cases in which they are injected into aegyo-sal under the eyes or sunken areas under the eyes, making the eye area look unnatural or causing side effects.

Many people suffer from filler side effects, so caution is needed.

Also, because fillers are transparent in color, when injected under the eyes, the color often becomes pale and looks unnatural.

There are also cases where a curved shape is created or the filler spreads and causes a bulge in an unintended area.

Fillers are not for use under the eyes; they are for correcting fine wrinkles around the eyes.

Many people complain that filler procedures under the eyes make the under-eye shape look unnatural or cause side effects, so they should absolutely not be performed under the eyes.

They should not be injected not only under the eyes, but also into the nose, lips, or cheeks.

Fillers should only be used for fine wrinkles around the eyes, fine forehead wrinkles, fine wrinkles around the mouth, and small depressed scars.

Once an incorrect shape or side effect appears after a filler procedure, correction is almost impossible.

There are many cases in which people contact our clinic for correction because of incorrect filler procedures at other hospitals, but there is no special correction method, so getting filler under the eyes is a no-go.

Cause 3 of under-eye dark circle treatment failure.

Fat repositioning with the wrong indication

Under-eye fat repositioning is not a surgery that simply makes the color under the eyes brighter.

Under-eye fat repositioning is a contour-correction procedure that moves fat to the area below the protrusion instead of removing orbital fat, thereby correcting both the protruding and sunken areas at the same time.

However, in many cases, there are eyes in which there is not enough fat to justify fat repositioning, yet the procedure is still recommended.

In such cases, fat repositioning often leads to hollowness under the eyes or no correction at all.

The problem with fat repositioning is that the under-eye color hardly becomes brighter, and it is also difficult to create the desired smooth contour.

Since the surgery is performed through the conjunctiva, the field of view is limited and the procedure is not carried out properly, so it should be kept in mind that there are not many people who are truly ideal candidates for good results from fat repositioning.

Four unsatisfactory points of fat repositioning

1. When the amount of fat is insufficient, the protruding area where the fat used to be may become sunken after fat repositioning
2. When the amount of fat is large, the original protruding area may still appear protruded after fat repositioning
3. After fat repositioning, the original sunken area may instead appear bulged
4. When the amount of fat is small, the original sunken area may not be properly filled even after fat repositioning and may still look sunken and shadowed

Under-eye fat repositioning is usually unsatisfactory or unnatural in actual results when applied carelessly to people who do not have much orbital fat.

Also, little improvement in under-eye color can be expected from fat repositioning, and it should only be performed for contour correction.

However, cases in which the desired smooth under-eye area is actually created are extremely rare.

There are many cases at other hospitals where fat repositioning is recommended for eyes that have almost no protruding under-eye fat, and this is something to consider carefully.

After under-eye fat repositioning, there are cases in which the under-eye area becomes sunken or protruded rather than smooth, leading people to visit our clinic for correction; if it is sunken, correction with micro fat grafting is possible again.

Cause 4 of under-eye dark circle treatment failure.

When fat removal and fat grafting are performed at the same time

It is best not to perform fat removal and fat grafting at the same time if possible.

At other hospitals, fat removal and fat grafting are sometimes recommended together, with fat grafting done immediately after fat removal.

In such cases, it is difficult to obtain satisfactory results.

At our clinic, there are also cases where fat grafting is performed after fat removal, but fat removal is done only when absolutely necessary and is not performed at the same time as fat grafting.

Usually, the procedures are done with a one-month interval.

The reason is that once the result of fat removal is visible, we can design the treatment accurately and adjust the amount of grafted fat according to the degree of hollowness for a more precise procedure.

However, if fat grafting is done immediately after fat removal without knowing how much and where the area will settle, proper fat grafting cannot be achieved.

This is the same as roughly coloring something when you do not even know how the sketch will turn out.

In an under-eye procedure that requires great precision, such an act goes against the principles of proper treatment.

In some cases, there are eyes that do not need fat removal at all, or cases in which fat removal is suggested together with grafting even though the eyes are already sunken.

Fat removal should only be performed when under-eye protrusion is severe.

If fat removal is performed unconditionally without considering whether there is much or little fat under the eyes, it is beyond common sense.

Plastic surgery is a field that requires specialized knowledge, but judgment should still be extremely common-sense based.

If there is protrusion, fat removal is appropriate, but if fat removal is recommended for eyes with almost no protrusion and fat grafting is also recommended at the same time, it should clearly be reconsidered.

There are many cases in which people contact our clinic for correction after unsatisfactory results from simultaneous fat removal and fat grafting at other hospitals.

Such nonsensical procedures should not be performed on the under-eye area, which requires delicate treatment.

1. When orbital fat under the eyes is protruding and there is a sunken wrinkle line beneath it

In this photo, there is protruding orbital fat under the eyes and a sunken wrinkle line beneath it, so our clinic planned fat removal and fat grafting.

2. The protruding area has improved, but the sunken wrinkle line remains, so fat grafting is planned one month later

First, fat removal was performed to correct the protruding area under the eyes.

However, the sunken wrinkle line beneath the fat removal area was not corrected.

Fat removal is a surgery that corrects under-eye protrusion, and in some cases it does not resolve the sunken wrinkle line under the eyes.

3. Appearance after fat grafting one month after fat removal

One month after fat removal, the sunken wrinkle line remained, so it was precisely designed to match this and the appropriate amount of fat was grafted.

After the procedure, the shadow line under the eyes disappeared and the dark circles improved.

In this way, after the results of a previous procedure are visible, you should confirm them and then make an accurate plan before grafting.

If fat removal and grafting are recommended at the same time, it should be reconsidered.

Also, if fat removal is recommended at the same time for eyes that do not need fat removal at all, that should also be reconsidered.

Cause 5 of under-eye dark circle treatment failure.

When correction is attempted with fat removal based on incorrect judgment

Fat removal is a surgery in which orbital fat under the eyes is removed to flatten the protruding area when the under-eye area is protruded.

In cases where the under-eye area is severely protruded and the skin of the protruding area has a reddish tone, fat removal can be applied to achieve a flatter under-eye area while also reducing the redness.

However, if the under-eye protrusion is not severe and the dark circles are dark, fat removal can increase skin density due to skin contraction, making the under-eye area even darker. If the under-eye area becomes sunken overall, it creates a shadow effect and looks darker, resulting in the opposite effect.

Since fat removal alone often fails to produce a treatment effect or may worsen the dark circles, it should only be performed when the exact surgical indication is met.

However, it is important to understand that fat removal alone has clear limitations in solving dark circles.

Cause 6 of under-eye dark circle treatment failure.

Incorrect treatment indications

Making aegyo-sal with the wrong indication

The cases in which dark circles can be treated by creating aegyo-sal under the eyes are the dark circles just below the eyelashes.

By creating aegyo-sal in this area, the skin can be expanded and the color can be lightened along with the formation of the aegyo-sal, which can help correct dark circles. However, if the under-eye area is dark overall or sunken, the shadow effect can become more noticeable, making the under-eye area look even darker.

Therefore, aegyo-sal should only be performed when the correct indication is met.

Micro fat grafting with the wrong indication

Fat grafting is only applicable when the under-eye area is at least somewhat sunken.

If there is a lot of fat and the under-eye area is protruding, or if the eyes are flat, fat grafting can have the opposite effect because the under-eye area may protrude even more after the procedure.

Micro fat grafting can only be applied when the under-eye area is even slightly sunken.

Also, micro fat grafting under the eyes is an area that requires a very delicate technique and experience.

If fat is grafted poorly, side effects such as unevenness under the eyes can occur, and the shape often turns out unnatural, so caution is required.

Therefore, under-eye fat grafting is an area where the practitioner’s experience and expertise are most needed.

Lower blepharoplasty with the wrong indication

Lower blepharoplasty is a surgery that pulls the skin under the eyes to smooth wrinkles, and it can be applied to dark circles caused by many fine wrinkles under the eyes.

However, in red dark circles with thin skin, even if wrinkles are present, the red dark circles may appear even more prominent after surgery.

The reason is that pulling and smoothing the skin makes it even thinner, causing the red muscle layer beneath the skin to show more.

Therefore, if the skin is too thin, caution is needed because lower blepharoplasty can make the redness under the eyes appear even stronger.

Cause 7 of under-eye dark circle treatment failure.

Vitamin C administration method

If the skin under the eyes is thin, vitamin C can be administered to try to thicken the skin under the eyes, but the effect is less than expected.

Although vitamin C is said to thicken the stratum corneum of thin skin so that the red orbicularis muscle layer and blood vessels are less visible, the skin does not easily become thicker.

Since no other effects beyond thickening the stratum corneum of thin skin can really be expected, it should be viewed as only an auxiliary measure for dark circle treatment; it is difficult to treat dark circles with this procedure alone.

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Some dark circles cannot be easily corrected depending on their shape, and the method that suits each person should be decided after a careful examination.
This is a clinic where procedures are performed by board-certified plastic surgeons, and it has more than 20 years of extensive clinical surgical experience with dark circles, ongoing research, and an after-care system.
The 5-step solution of Duhan Plastic Surgery’s dark circle clinic is centered on accurate judgment and surgery for various dark circle symptoms. It is not simply about removing dark circles; for youthful and beautiful eyes, it operates a dark circle combo program and an after-care system for thorough management.
"Over 30,000 clinical surgeries" Dr. Shin Duhan has specialized the dark circle clinic at Duhan Plastic Surgery and has accumulated more than 30,000 clinical surgical experiences to date.
"Registered trademark service rights for COL-FAT fat grafting" Through ongoing research and development in fat grafting surgery, Dr. Shin Duhan obtained registered trademark service rights for COL-FAT fat grafting.
"Dr. Shin Duhan, drawing media attention" Domestic and international media are paying attention to Dr. Shin Duhan, a leader in the dark circle field.
"Continuous research activities" New research findings on dark circles are being presented at domestic and international academic conferences and seminars, including the International Society of Plastic Surgery and plastic surgery symposiums.

​http://www.darkcare.com​