[Duhan Plastic Surgery Micro Fat Grafting] - [Upper Eyelids]

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Micro fat grafting for the face

Soft and beautiful facial contours

What is upper eyelid (sunken eyelid) fat grafting?

Upper eyelid micro fat grafting is a procedure applied when the eyelids have sunken in and make the face look tired or older. It is a procedure that aesthetically restores sunken eyelids and, functionally, helps you open your eyes more comfortably.

Indications for upper eyelid (sunken eyelid) fat grafting

○ Restores sunken eye contours to a fuller appearance

○ Improves discomfort or fatigue when opening the eyes

○ Reduces an overly large double eyelid line caused by eyelid hollowing

○ Helps relieve symptoms of eye protrusion when protruding eyes are present

The role of orbital fat

○ Gives the eyelid contour more volume and softness.

○ Protects the eyeball from external impact.

○ Serves as a lubricant so that the levator palpebrae superioris muscle (the muscle that lifts the eyelid) can move smoothly.

Effects obtained from upper eyelid (sunken eyelid) fat grafting

Aesthetic aspect	Restores the hollow area for a softer and more youthful eye shape
Functional aspect	Reduces eyelid fatigue by making the movement of the levator palpebrae superioris muscle that opens the eyes smoother.

The location of upper eyelid (sunken eyelid) fat grafting

The treatment goal of upper eyelid fat grafting must satisfy both aesthetic and functional purposes.

To achieve this, it is very important to graft an appropriate amount of fat into the correct location.

The most accurate location for fat grafting is the area where orbital fat is located, and the best results are achieved when the newly grafted fat blends with the existing fat in this area.

However, if it is grafted incorrectly into the orbicularis muscle layer, the eyelid can become lumpy and, instead, feel heavier, making it more uncomfortable to open the eyes.

Therefore, upper eyelid fat grafting must be performed delicately with precise grafting based on accurate anatomical knowledge in order to achieve the desired results.

The process of upper eyelid (sunken eyelid) fat grafting

Effect of the tunneling technique
Rather than injecting a large amount into one place with the tunneling technique, we perform three-dimensional micro fat grafting with 100% concentrated fat distributed evenly across multiple layers. A customized design is possible using a delicate and careful injection method. Fat grafting also includes a process called "tunneling," which allows the grafted fat to make maximum contact with the surrounding abundant blood vessels so it can continuously receive nutrients.
Tunneling means using a micro needle just beneath the skin to create a place for the fat to go. Because space is prepared as if drilling a tunnel and then the fat is injected, the fat does not sag in the direction of gravity or become lumpy after all of it has been placed.

1. Since the amount of fat needed for eyelid fat grafting is not very large, it is mainly best to harvest it from the lower abdomen.

• Because local anesthesia (painless sedation anesthesia) is used, there is no pain at all.

• A thin liposuction cannula is used to collect the fat into a syringe.

2. The harvested fat is centrifuged to remove impurities (anesthetic, oil, blood, etc.).

3. Oil is removed through a second purification step.

Only when almost all the oil has been removed can it truly be called concentrated fat.

4. The purified fat is placed into a thin 1 cc syringe.

Usually, about one 1 cc syringe is grafted into one eyelid.

5. A micro fat grafting cannula is inserted along the planned line of the eyelid to perform the grafting.

At our clinic, we use a micro needle (micro grafting cannula) developed in-house.

The micro needle is a special grafting cannula used only at our clinic, enabling ultra-precise grafting.

The graft must be placed into the orbital fat layer to create a smooth contour and a high survival rate.

6. After fat grafting, you can return to daily life immediately, and washing your face and applying makeup are possible starting the next day.

Examples of upper eyelid (sunken eyelid) fat grafting procedures

Two-dimensional planar fat grafting for the upper eyelid (sunken eyelid)

Fat grafting in the upper eyelid (upper blepharoplasty area) should be done as two-dimensional planar fat grafting.

If fat is grafted into the orbicularis muscle layer under the skin, the eyelid may become heavier and the skin may become lumpy.

To avoid these side effects, fat must be grafted accurately between the orbicularis muscle and the levator palpebrae superioris muscle, and this requires precise anatomical knowledge and extensive experience.

Only when the fat is grafted two-dimensionally into the orbital fat layer can the upper eyelid fat grafting be functionally and aesthetically complete.

Recovery period after upper eyelid (sunken eyelid) fat grafting

Usually, normal activities are possible right away.

There may be slight swelling and bruising, but it is usually mild enough to be covered with makeup, so it does not cause major problems in social life.

However, swelling and bruising vary from person to person, so not every case is the same. On average, severe swelling and bruising do not occur, and it is common for the results to look much more natural after about a week.

Number of upper eyelid (sunken eyelid) fat grafting sessions

Eyelid fat grafting has a relatively high survival rate compared with other areas.

Depending on the case, one session may be enough, and in other cases two sessions can produce satisfactory results.

The interval between procedures is between 3 and 10 months, and for repeat procedures, the fat that was stored when the first graft was performed is thawed and used.

However, if a patient is satisfied after just one procedure, a second procedure is not always necessary.

Because the survival rate of fat varies from person to person, the decision on whether to perform a second procedure should be made after at least 3 months.

Fat graft survival and survival rate

The survival rate of fat cells differs by area of the face.

The higher the survival rate, the fewer procedures are needed and the greater the effect.

For example, a survival rate of 80% means that 80% of the total grafted fat survives and 20% is absorbed and disappears.

Therefore, the higher the survival rate, the better the result.

The area with the lowest survival rate is the lips, and the area with the highest survival rate is around the eyes.

The average survival rate after fat grafting is 50%.

In other words, after grafting 100 units of fat, only 50% remains after several months.

The better the blood circulation in an area, the higher the fat survival rate. Since the area around the eyes has the best blood circulation on the face, the survival rate is higher than in other areas.

Therefore, around the eyes, permanent results can be achieved with just one procedure.

However, because repeat procedures are sometimes needed, it is best to think of fat grafting as something that may be done about twice.

Second procedure and fat harvesting

When fat is harvested from the lower abdomen or thighs, a sufficient amount is collected for grafting, and any fat left over after the procedure is not discarded but stored sterile in a freezer.

The fat stored this way can be kept for about 10 months, so if you return within 10 months, you can receive an additional procedure without harvesting more fat.

Whether the fat is stored and then used or harvested and used immediately, the result is the same.

Long-term effects of upper eyelid (sunken eyelid) fat grafting

After fat grafting, the volume decreases as some of the fat is absorbed over 3 to as long as 6 months.

After that, once the fat has fully survived and no further absorption occurs, the remaining fat stays permanently.

The surviving fat does not naturally melt away.

If your overall body weight decreases in the future, the grafted area may also be affected, but if your weight remains the same, the volume in the grafted area also changes very little.

Therefore, the surviving fat remains as your own tissue for life.

Of course, this does not mean the shape itself lasts forever.

As you age, the skeleton changes, wrinkles form in the eyelids, the skin sags, and weight loss can occur, so the shape of the grafted area does not remain exactly the same.

Before aging progresses significantly, the effect lasts continuously.

That is why the term "semi-permanent" is used.

Side effects of upper eyelid (sunken eyelid) fat grafting

The side effects are limited to slight swelling and bruising.

Other side effects can be considered nonexistent.

Because the procedure uses your own fat rather than a foreign substance, there is no biological rejection or inflammation.

Also, once the fat survives, it is no longer absorbed and becomes your own tissue.

Sometimes people experience side effects after undergoing the procedure at a clinic with somewhat limited fat grafting experience, but that is an issue of the practitioner’s technique.

Problems can occur, such as grafting into the orbicularis muscle layer instead of the orbital fat layer, which makes the eyelid heavier and lumpy; overinjection of fat, which causes the eyelid to swell and makes normal daily life difficult; ptosis caused by overinjection, resulting in difficulty opening the eyes; or a large amount of fat being absorbed, leading to no visible effect.

Because the results differ from clinic to clinic, in principle you should not undergo the procedure with a non-specialist plastic surgeon who has limited fat grafting experience.

Other methods besides fat grafting

If fillers (Restylane, Juvederm, Artecoll, etc.) are injected, the eyelid may become stiff and make opening the eyes uncomfortable, and inflammation may also occur.

Eyelid hollowness should not be corrected with fillers.

For all areas of the face, including eyelid hollowness, micro fat grafting using autologous tissue is a safe and effective method.

Frequently asked questions about upper eyelid (sunken eyelid) fat grafting

Is it true that eyelid fat grafting has many side effects, so it should not be done at other clinics?

That is not true of all other clinics.

The areas that require the greatest experience and skill in fat grafting are the upper eyelids and under-eye dark circles.

These are areas that cannot be treated carelessly without accumulated experience and skill.

We always say in our consultation room that fat grafting is absolutely not a procedure that just anyone can do.

As with all surgeries, the results differ depending on the surgeon’s experience and know-how.

There are many clinics that perform fat grafting, but only a few truly do it properly.

Fat grafting may be easy to perform, but it is difficult to achieve proper results.

In principle, fat grafting can produce good results only when performed accurately.

The technique differs from clinic to clinic, and the results vary greatly depending on experience.

You may have a bad impression after hearing about or experiencing incorrect fat grafting, but if it is done properly, satisfactory results can be achieved with just one procedure.

In particular, the upper eyelid area (sunken upper eyelid, sunken upper eyelid) requires a great deal of experience, skill, delicacy, and precision, so it cannot be done by just anyone.

I had eyelid fat grafting at another clinic, but it has mostly sunken again and there is almost nothing left. Is repeat treatment possible in this case?

Repeat treatment is possible even after the area has mostly sunken again due to low survival after treatment at another clinic.

However, it must be performed at least 3 months later.

The survival period for fat grafting takes at least 3 months, so once 3 months have passed since the last procedure, you can receive treatment again.

Even if it is a repeat procedure at our clinic, the result is almost no different from the first one.

I had eyelid fat grafting at another clinic, and it is lumpy and uncomfortable to open my eyes. Is this a side effect?

The goal of eyelid fat grafting is to restore sunken eyelids and, functionally, improve the ability to open the eyes and reduce eye fatigue.

To achieve this goal, the procedure must be precise and delicate.

With fat grafting performed by someone with somewhat limited experience, problems can occur, such as grafting into the orbicularis muscle layer instead of the orbital fat layer, causing irregular contours, or grafting near the deep levator palpebrae superioris muscle layer, making it even more uncomfortable to open the eyes than before the procedure.

If these side effects occur, the fat must be removed again, which is a very difficult problem.

To prevent these side effects, it is best not to undergo the procedure with someone who lacks experience or with a non-specialist plastic surgeon.

What if fillers are injected into the eyelids instead of fat grafting?

Because the eyelids are structures that move continuously, procedures that interfere with eyelid movement should not be performed.

If fat is grafted, it acts as a cushion and lubricant that makes eyelid movement smoother. But if a foreign substance such as filler is injected, it can cause serious problems with the function of opening the eyes, regardless of the eyelid’s shape, and in severe cases swelling may not subside or the eye shape may become distorted.

It can even cause inflammation, so fillers should absolutely not be injected into the eyelids.

Is eyelid fat grafting risky because it is close to the eyeball?

Not at all.

The risk is high when the procedure is performed by a doctor with somewhat limited experience or by a non-specialist plastic surgeon. If it is performed accurately by an experienced specialist, there is no need to worry.

Eyelid fat grafting must be performed by someone with accurate anatomical knowledge and know-how gained through extensive double eyelid surgery experience, and if the procedure is done according to proper principles, it is one of the safe procedures that is not risky.

After eyelid fat grafting at another clinic, I developed a bulging side effect. Can it be corrected?

Sometimes people come to our clinic for correction because overinjection of fat at another clinic has made the eyelids heavy and bulging.

Depending on the condition, the fat may need to be removed by suction. If the fat can be grasped by hand as a lump, correction can be done by inserting a fine cannula and suctioning it out.

However, 100% removal is impossible, and usually about 50% to 80% can be removed and corrected.

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Features and competitiveness of Duhan Plastic Surgery’s autologous fat grafting clinic

1. All anesthesia is performed with local anesthesia (sedation anesthesia).

Local anesthesia is performed together with sedation anesthesia, and the procedure is carried out without any pain, both during and after anesthesia.

2. It has a systematic and advanced fat grafting system.

To harvest living fat cells and increase purity, centrifugation refinement and removal of unnecessary oil are used to maximize purity.

Before grafting, subcutaneous tunneling is performed in the graft site to secure space for the grafted fat.

Precise grafting is performed using a micro fat grafting cannula.

Three-dimensional grafting across multiple layers maximizes survival rate and creates a soft contour.

3. Appropriate and various fat harvesting sites are selected.

The most commonly used area is the lower abdomen. Because there is less pain after the procedure, less swelling and bruising, and it is a comfortable area for daily life, it is often chosen first.

After the lower abdomen, the next choices are the inner thighs, then the outer thighs.

If there is not enough fat to harvest from the thighs, the lower buttocks or the flanks may also be used.

There is no fixed rule about which area provides the best survival rate.

The results are similar, and the area with the most excess fat is ideal for harvesting. However, it is best to decide the harvesting site by considering the amount of fat needed and post-procedure activity.

4. A two-step purification process for harvested fat maximizes survival rate.

Among the impurities in harvested fat, local anesthetic accounts for the highest proportion, followed by oil.

Other impurities such as serum and red blood cells are also included.

In the first step, the fat undergoes centrifugation for about 3 to 4 minutes before moving on to the second oil-removal process.

Oil is removed manually through a natural absorption method.

Through the two-step purification process, nearly 100% concentrated fat is obtained, maximizing the effectiveness of fat grafting and increasing the survival rate as much as possible.

5. Subcutaneous tunneling creates space for fat grafting.

Subcutaneous tunneling is the process of creating space in advance where the fat will be grafted. It is an essential and important step for a high survival rate and even grafting.

Using a thin probe, the area under the skin is moved repeatedly in a fan-like pattern to create the space for the fat to be grafted.

The effect of subcutaneous tunneling is to improve fat survival and prevent fat from clumping, creating an even and soft contour.

6. Three-dimensional micro fat grafting creates a soft and even facial contour.

Although there are exceptions depending on the area, the basic grafting method for fat grafting is the three-dimensional method.

Fat is divided into multiple layers and grafted in small amounts evenly across each area.

7. A micro fat grafting cannula is used for precise grafting.

In the past, methods that used fat injection machines pushed fat under the skin with high pressure, causing various problems.

The absorption rate of the fat was high, survival was inconsistent, and the contour became lumpy, making it difficult to graft into precise areas such as under the eyes.

To solve these problems, the fat is transferred again into a thin 1 cc syringe during grafting and then injected into the desired area.

Duhan Plastic Surgery’s autologous fat grafting clinic uses a micro needle (micro grafting cannula) developed in-house.

The micro needle is a special grafting cannula used only at our clinic, enabling ultra-precise grafting.

Fat grafting can be performed in the upper eyelids, lower eyelids, forehead wrinkles, glabella wrinkles, nasolabial folds, and the bridge of the nose, making fat grafting possible in almost all cases except fine wrinkles.

8. Molding immediately after fat grafting helps create an even and soft facial contour.

Immediately after fat grafting, delicate molding is performed so the grafted fat spreads evenly and creates a soft shape.

Molding is the final step of fat grafting and one of the most important steps.

9. Sterile deep-freeze storage of leftover fat makes second procedures easier.

When a second procedure is performed 3 months after fat grafting, the fat remaining after the first procedure is used instead of harvesting fat again.

The fat remaining after the first procedure is rapidly frozen and stored under sterile conditions.

For the second procedure, the stored fat is thawed and the procedure can be done more easily.

The storage period for fat is up to one year, and if you visit within one year, the stored fat will be used for the procedure.

10. Based on more than 20 years of extensive clinical experience and know-how, Duhan Plastic Surgery’s autologous fat grafting clinic performs multilayer (layer-by-layer) fat grafting.

The key to fat grafting is ensuring that the fat cells are living cells with a high survival rate.

To increase fat survival, a large amount is not injected into one place; instead, it is grafted evenly across multiple layers.

Between the skin and bone there are several tissues such as fat and muscle layers, and fat must be injected in a multilayer structure without overlap, such as between the periosteum above the bone and between the muscle and fascia above and below the muscle.

Multilayer fat grafting lasts 3 to 4 times longer than conventional methods, and fat survival is also higher.

Fat grafting at Duhan Plastic Surgery’s autologous fat grafting clinic also includes a process called "tunneling," which allows the grafted fat to make maximum contact with the surrounding abundant blood vessels so it can continuously receive nutrients.

Tunneling means using a micro needle just beneath the skin to create a place for the fat to go. In other words, space is created as if drilling a tunnel, and then the fat is injected, so even after all the fat has been placed, it does not sag in the direction of gravity or become lumpy.

In addition, a delicate injection method allows for customized design.

Through thorough aftercare following fat grafting, we carefully monitor progress until the fat has fully survived.

During follow-up, if needed, we try to minimize dissatisfaction by using swelling-reduction injections, shape correction, and molding.

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