[Duhan Plastic Surgery Fat Grafting] - [Under-Eye Dark Circles]

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Under-eye dark circles

Dark circles - Micro fat grafting for under-eye wrinkles

What is under-eye fat grafting?

This is a procedure performed when the under-eye area is sunken or hollow, or when dark circles make the eyes look unattractive due to hollow wrinkle lines. Fat is harvested from the lower abdomen or thighs using a thin suction cannula, and then grafted under the eyes using a micro fat grafting cannula to correct hollowness or wrinkle lines under the eyes and brighten the skin tone.

How to make the eye area look brighter and younger

◇ Upper eye area - Usually, double eyelid surgery is performed to make the eyes appear larger visually.

Fat grafting is used on sunken eyelids to restore a hollow-looking eye area.

◇ Lower eye area - Through fat grafting, a plump lower-eyelid volume can be created, or hollow wrinkle lines and dark circles can be corrected to make the area look brighter and younger.

Types of under-eye dark circles

Causes of dark circles

◇ Under-eye hollowness (sunken area) - When the under-eye area sinks in, shadowing occurs and it inevitably looks dark.

◇ Color of the orbicularis muscle under the eye - All muscles have a reddish color, so the orbicularis muscle appears red.

◇ High skin density - The higher the skin density, the darker the skin and the more fine wrinkles there are.

◇ Melanin pigmentation in the skin - Melasma, freckles, age spots, and so on

Principles of correcting dark circles with micro fat grafting

◇ As fat grafting corrects under-eye hollowness, the dark shadowing effect is reduced.

◇ By expanding the skin, fine wrinkles and the density of skin melanin pigmentation can be reduced.

◇ By placing yellow fat under the skin, the dark reddish color can be diluted and lightened.

Below the under-eye skin layer lies the reddish orbicularis muscle layer, so the main cause of dark reddish dark circles is that the color of this muscle layer is projected through the skin.

​To prevent the reddish color of this muscle layer from showing through, yellow fat is precisely grafted into or just above the muscle layer so that, on the outside, skin-toned color appears instead of red. That is the principle of the procedure.

For this procedure to be possible, the under-eye area must have at least some degree of hollowness.

Cases where fat grafting can be effective

Micro fat grafting under the eyes is suitable when the under-eye area is somewhat sunken.

If the under-eye area is not sunken but instead protruding, the orbital fat under the eyes should first be removed before fat grafting. If fat grafting is performed while the area is protruding or flat, the under-eye area may look even more protruded, which can produce an adverse effect.

Cases where fat grafting is not effective

◇ Dark circles with a protruding under-eye shape

◇ Cases with excessive under-eye wrinkles

◇ Dark circles with severe skin sagging

The process of under-eye fat grafting

​1. Fat is harvested from areas where the body stores a lot of fat, such as the lower abdomen, waist, or thighs.

• Since 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 solution, oil, blood, serum, moisture, etc.).

3. Oil is removed through a second refining process.

Only when most of the oil has been removed can it truly be called concentrated fat.

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

Although it varies by person, usually about half to one 1cc syringe is grafted per eyelid.

5. A micro fat grafting cannula is inserted along the predesigned under-eye line and the fat is grafted.

The clinic’s in-house developed microneedles (micro grafting cannulas) are used.

Microneedles are special cannulas used only at this clinic that enable ultra-precise grafting.

The graft is placed within and above the orbicularis muscle layer, creating a smooth contour and a high graft survival rate.

6. After the grafting, you can return to daily life immediately, and face washing is possible starting the next day.

Understanding micro fat grafting under the eyes

Anatomy of under-eye dark circles and understanding fat grafting

In the photo above, there are two causes of dark circles.

One is shadowing caused by under-eye hollowness, and the other is dark circles caused by melanin pigmentation in the skin.

To correct this, micro fat grafting is performed to eliminate the shadowing effect and allow more light in, and yellow fat is placed between the orbicularis muscle layer and the skin to dilute the black color toward a skin-toned appearance.

In other words, the goal is to make yellow fat project through instead of the black color of the skin.

The success of the procedure depends on how smoothly and precisely the appropriate amount of fat is grafted.

Anatomy of under-eye hollow wrinkles and understanding fat grafting

The under-eye hollow wrinkle in the photo above is an S-shaped wrinkle line with no skin sagging at all.

To correct this, fat is grafted beneath the wrinkle-line skin so that the wrinkle is pushed up to the level of the surrounding skin tissue and smoothed out.

Under-eye fat grafting should be performed delicately using a micro fat grafting cannula without making any incision in the skin, and the success of the procedure depends on how evenly the appropriate amount of fat is injected.

Examples of under-eye micro fat grafting

Under-eye micro fat grafting should basically be performed as three-dimensional fat grafting.

Usually, the grafting is divided below the orbicularis muscle layer, within the orbicularis muscle layer, and above the orbicularis muscle layer.

For this, subcutaneous tunneling is an essential part of the process, and bruising occurs at this stage.

The area around the eyes has many blood vessels, so some degree of bruising has to be accepted.

If tunneling is skipped in order to minimize bruising and the graft is placed directly, bruising may be less, but in most cases the shape becomes awkward or lumpy, so thorough preconditioning through subcutaneous tunneling before grafting is necessary to achieve good results.

The effect of fat grafting on dark circles

Dark circles refer to the phenomenon in which the skin under the eyes becomes dark or dark reddish, making the eyes look dull.

In some cases, the skin color has changed, and in others, the skin appears dark because fine wrinkles increase as the skin gathers too tightly.

Or the reddish muscle layer may show through the thin skin and appear red.

Although fat grafting cannot change the skin color itself, in cases where dark circles are caused by skin gathering like a rubber band, creating lower-eyelid fullness can expand the skin and make the skin tone appear lighter. In cases of dark reddish dark circles where the muscle layer is visible, grafting fat under the skin can create a color-complement effect between the yellow fat and the dark blue color, making the skin appear lighter.

Number of fat grafting sessions

How many times fat grafting is needed depends on the survival rate of the fat.

This varies from person to person.

With fat grafting, one session to a maximum of two sessions at intervals of about three months is usually enough to achieve satisfactory results.

Because the survival rate of fat is higher under the eyes than in other areas, satisfactory results are often achieved with just one session.

Fat survival and survival rate

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

The higher the survival rate, the fewer the treatment sessions 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.

Therefore, the higher the survival rate, the greater the corrective effect.

The area with the lowest survival rate is the lips, and the areas with the highest survival rates are the cheeks and around the eyes.

The average survival rate after fat grafting is 50%.

In other words, after grafting a volume of 100 units of fat, only 50% will remain after a few months.

The better the blood circulation in the area, the higher the fat survival rate, and since the area around the eyes has the best blood circulation among facial areas, the survival rate is relatively higher than in other areas after fat grafting.

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

However, because repeat procedures are sometimes performed, it is a good idea to think of it as a treatment that may be done about twice in order to achieve satisfactory results.

Whether fat is harvested again for a second fat grafting procedure

When fat is harvested from the lower abdomen or thighs, enough fat is collected for grafting, and any remaining fat is not thrown away but stored sterilely in a freezer.

The fat stored this way can be kept for about 10 months, so if you visit within 10 months, you can receive a repeat procedure in the desired area.

Returning to daily life after fat grafting

You can resume activities immediately.

There may be some swelling and bruising, but since the bruising can be covered with makeup, it does not cause major problems in social life.

If swelling is significant, an injection to reduce swelling can make it go down right away, so there is no need to worry too much about swelling.

Side effects of fat grafting

The side effects are usually just slight swelling and bruising.

Other side effects can be said to be virtually nonexistent.

Some people worry that the under-eye contour may not be smooth and may become bumpy, but this is related to the surgeon’s experience and skill.

Therefore, under-eye fat grafting requires extensive experience and know-how, and it is absolutely not a procedure that anyone can do.

Under-eye procedures require delicate technique and the even injection of an appropriate amount of fat to achieve good results.

Ultimately, the success of the procedure depends on how properly the practitioner performs it.

For this, subcutaneous tunneling is performed and a micro fat grafting cannula is used so that no incision is made under the eyes, and the appropriate amount must be delicately grafted into the hollow area to achieve good results without side effects.

Also, if an awkward shape occasionally appears, the practitioner must have the ability to correct it simply and immediately.

Other methods besides fat grafting

Of course, various fillers used in plastic surgery (Juvederm, Restylane, Perlane, Alloderm, Suarderm, Juvederm, Artecoll) are available and used.

However, these filling materials have their own specific purposes.

They are products used for fine wrinkles around the eyes, between the eyebrows, or on the forehead, or for small depressed scars such as chickenpox scars.

If they are misused to correct under-eye hollowness or dark circles, there is a high risk of side effects, and these filling materials should not be used to correct dark circles.

For under-eye hollowness or dark circle correction, micro fat grafting is the only effective method.

In addition, although various dermatologic procedures are performed to correct dark circles, it is true that the results are often not satisfactory.

Typical whitening treatments and vascular laser treatments have little treatment effect expected.

Also, if only the under-eye fat is removed, the under-eye area becomes hollow, which can worsen dark circles, so fat should not be removed carelessly.

Since dark circles caused by skin color are also rare, whitening treatment has little effect, and the effect of whitening means changing dark skin to white skin, which is like turning a Black person into a White person, so it is not realistically possible.

Vascular laser treatment also cannot change the color of the dark reddish muscle layer under the eyes, so no treatment effect can be expected.

Because there is no way to change the color of the skin or the reddish muscle layer, experience shows that grafting yellow fat between the two layers is a good way to make the under-eye area appear closer to skin tone.

Common questions and answers about under-eye dark circle treatment

What is the best treatment for dark circles?

Dark circles have various shapes and patterns depending on the person.

It is not possible to say that one method is better than another.

The appropriate treatment differs for each person depending on the cause and symptoms.

In some cases, fat grafting must be performed; in other cases, removing fat can relieve the symptoms; and in some cases, lower blepharoplasty that removes skin is the only way to achieve results.

In other words, it is important to perform the procedure that suits each eye area.​

I heard under-eye micro fat grafting often causes bumps and many side effects. Is that true?

Under-eye fat grafting is not a procedure that just anyone can do.

As with all surgeries, the outcome depends on the surgeon’s experience and know-how.

There are many clinics that perform fat grafting, but the number that do it properly can be counted on one hand.

Fat grafting is easy to do, but difficult to produce proper results.

People may think fat grafting is easy, but it is absolutely not.

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

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

You may have a negative preconception after hearing about or experiencing a poorly performed fat graft, but if it is done properly, satisfactory results can be achieved with just one procedure.

How is under-eye micro fat grafting performed?

Under-eye fat grafting is one of the most technically demanding and delicate areas among fat grafting procedures.

Therefore, if done carelessly, side effects can occur.

To prevent side effects, all steps must be carried out precisely in principle.

The fat should be harvested in as small particles as possible, all impurities completely removed, space for even grafting should be created in the treatment area through tunneling, and then an appropriate amount should be delicately and evenly grafted to achieve good results.

A special cannula equipped with a micro needle of about 1 mm in diameter is used for very precise treatment.

It is best to receive treatment at a clinic with specialized know-how and many successful cases.

Why did color laser treatment not work even after several sessions?

A pigment laser is a laser that responds to red color and is mainly effective for people with red telangiectasia or red erythematous skin.

It is effective for redness in the skin itself, but applying it to red dark circles under the eyes is not realistic.

The reason is that the cause of the redness is not in the skin itself but in the entire reddish muscle layer under the eyes.

No matter how much laser is applied to this reddish orbicularis muscle layer, the red color cannot change.

As long as the muscle is alive, the red color cannot change.

If all the reddish muscle layer were burned away, the red color would disappear, but that would mean causing a severe burn under the eyes and leaving a scar, so it is impossible and should not be done to eliminate the muscle layer with a laser.

I had fat removed, but my dark circles got worse. Why?

The main purpose of fat removal is to resolve under-eye protrusion.

Sometimes there is a hollow wrinkle beneath the protruding area that creates a shadow, and fat is often removed to eliminate it, but if done incorrectly, it can easily have the opposite effect.

What happens when fat is removed is that the under-eye area becomes even more sunken than before the procedure.

A sunken eye area creates a shadow effect and looks darker.

Also, when fat is removed, the skin gathers and contracts, increasing skin density and making the skin tone darker.

Fat removal is best performed when the under-eye protrusion is severe and the protruding area appears strongly reddish.

In most other cases, dark circles worsen, so caution is needed.

How much improvement can be expected from micro fat grafting under the eyes?

The effects of under-eye fat grafting are fourfold.

It raises sunken skin to remove the shadow effect, skin expansion from fat grafting can lighten the skin tone, fine wrinkles are improved during the process, and laying yellow fat underneath can dilute dark reddish tones and make them lighter.

Because symptoms vary from person to person, the presence or absence of effect can only be judged through an in-person examination.

The procedure is usually performed only when a 50% to 90% improvement in dark circles is expected.

If the expected result is judged to be below that, it may be better not to perform the procedure at all.

The goal of fat grafting is not to completely eliminate the symptoms, but to relieve and improve the current dark circles as much as possible.

Can under-eye micro fat grafting be done at any clinic?

The under-eye area is a highly delicate region because fat must be finely dispersed under thin skin in particle-sized amounts.

Therefore, it is differentiated from ordinary fat grafting from the selection of the harvest site to the refining and grafting steps.

Using a micro fat grafting cannula that does not leave scars and grafting the appropriate amount accurately and evenly determines the success or failure of the procedure.

Therefore, without extensive experience and know-how, it is difficult to expect good results.

Inadequate under-eye fat grafting can produce results worse than not doing it at all, so great caution is required.

What do you think about using filler for under-eye hollow wrinkle lines?

The skin under the eyes is very thin.

Unless the procedure is done with great precision, it is difficult to achieve satisfactory results, and unevenness should not occur after treatment.

In the case of fillers, the color is transparent, so it is difficult to create a natural skin tone, and it is difficult to create a soft contour after injection.

A drawback is that if the shape looks awkward, it is very difficult to remove.

In contrast, fat grafting can create a natural skin tone, correct dark circles, and produce a natural-looking shape, so if performed precisely, bumps rarely occur.

This is possible only when the practitioner performs the treatment accurately.

Fillers are effective for improving fine wrinkles around the eyes or forehead, but using them under the eyes can cause many problems, so caution is needed.

How much swelling and bruising occur after micro fat grafting?

Although swelling and bruising vary by person, they usually disappear after about 1 to 2 weeks.

The under-eye area has many blood vessels, so bruising is inevitable after the procedure.

Whether mild or severe, bruising cannot be avoided.

If bruising occurs, makeup is the only way to cover it until it goes away.

When undergoing the procedure, you should take bruising and swelling into account.

Do I absolutely need a second procedure after micro fat grafting?

The survival rate after fat grafting varies by person, but usually about 50% remains after 2 to 3 months.

Sometimes the survival rate is good and more than 80% remains, and sometimes less than 30% remains.

Because the survival rate depends on individual constitution, it is only after about 3 months that it becomes possible to judge how much of the graft has survived.

The need for a second procedure is decided by looking at the result after 3 months.

If the result of the first procedure is satisfactory, a second procedure is not necessary.

However, if the survival rate unexpectedly drops, a second procedure is sometimes performed.

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