[Duhan Plastic Surgery Micro Fat Grafting] - [Improvement of Dark Circles and Under-Eye Wrinkles]

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Dark circles - Micro fat grafting for under-eye wrinkles

What is under-eye fat grafting?

When the under-eye area is sunken or has depressed wrinkle lines,

it is a procedure done when dark circles make the eyes look unattractive.

Fat is harvested from the lower abdomen or thighs using a thin suction cannula,

then grafted under the eyes with a micro fat grafting cannula,

correcting under-eye hollowness or wrinkle lines

and brightening the skin tone.

A way to make the eye area look brighter and younger

Above the eyes - Usually, double eyelid surgery is performed to make the eyes look bigger visually.

Fat is grafted into sunken eyelids to restore a hollow eye appearance.

Below the eyes - Through fat grafting, you can create fuller aegyosal under the eyes, or correct depressed wrinkle lines and dark circles to make the area look brighter and younger.​

Types of dark circles under the eyes

Causes of dark circles

● Under-eye hollowness (depression) - When the under-eye area is sunken, a shadow effect occurs, making it look dark.

● Color of the orbicularis oculi muscle under the eyes - The muscle around the root of the eye can also have a reddish color, so the orbicularis oculi muscle appears red.

● High skin density - The higher the density of the skin, the darker it looks and the more fine wrinkles there are.

● Melanin pigmentation in the skin - Melasma, freckles, age spots, etc.

Principle of correcting dark circles with micro fat grafting

● As fat grafting corrects under-eye hollowness, the dark shadow effect is reduced.

● By expanding the skin, fine wrinkles and skin melanin pigmentation can be made lighter.

● By laying yellow fat beneath the skin, the dark red color can be diluted and lightened.

Under the skin layer beneath the eyes lies the red orbicularis oculi muscle layer, so the main cause of dark red dark circles is the red color of this muscle layer being projected through the skin.

The principle of the procedure is to prevent the red color of this muscle layer from projecting outward by precisely grafting yellow fat into or just above the muscle layer so that skin-tone color is projected outward instead of red.

For this procedure to be possible, there must be some degree of depression under the eyes.

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 rather protruding, the under-eye orbital fat should be removed first before fat grafting. If fat grafting is done when the area is protruding or flat, the under-eye area may look even more protruded, which can backfire.

Cases where fat grafting is not effective

● Dark circles with a protruding under-eye shape

● Cases with excessive under-eye wrinkles

● Dark circles with sagging skin​​

The process of under-eye fat grafting

​1. Fat is harvested from areas where fat is abundant, such as the lower abdomen, waist, or thighs.

• Since local anesthesia (painless sleep anesthesia) is used, there is no pain at all.

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

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

3. Oil is removed through a two-step purification process.

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

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

Although this varies by individual, usually about half to one 1cc syringe is grafted into each eyelid.

5. A micro fat grafting cannula is inserted along the planned design line under the eyes to perform the grafting.

We use the Micro Needle (micro grafting cannula) developed in-house.

The Micro Needle is a special grafting cannula used only at our clinic for ultra-precise grafting.

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

6. After grafting, normal daily activities can resume immediately, and washing the face is allowed from the next day.​

Understanding micro fat grafting under the eyes

Anatomy of under-eye dark circles and understanding fat grafting

There are two causes of dark circles above.

They are dark circles caused by a shadow from under-eye hollowness and dark circles caused by melanin pigmentation in the skin.

To correct this, micro fat grafting is performed to eliminate the shadow effect and allow more light to enter, and yellow fat is placed between the orbicularis oculi muscle layer and the skin to dilute the dark color and restore it closer to skin tone.

In other words, the goal is to make yellow fat project outward as skin tone rather than black skin color.

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

Anatomy of depressed under-eye wrinkles and understanding fat grafting

The depressed under-eye wrinkle above is a fold-like wrinkle line in a state where the skin is not sagging at all.

To correct this, fat is grafted into the layer beneath the wrinkle-line skin to push the wrinkle up to the level of the surrounding skin tissue and smooth it out.

Under-eye fat grafting must be performed with a micro fat grafting cannula and with no incision at all to the skin.

From experience and precise judgment, the success of the procedure depends on how evenly the appropriate amount of fat is injected.

Examples of micro fat grafting under the eyes

The effect of fat grafting for dark circles

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

In some cases, the skin color has changed; in others, the skin wrinkles have contracted excessively, creating many fine wrinkles and making the area look dark.

Or, in some cases, the reddish muscle layer beneath thin skin is visible, making it look red.

Although fat grafting cannot change skin color, in cases where dark circles are caused by the skin contracting like a rubber band, creating aegyosal can expand the skin and make the skin tone appear lighter. In cases of dark reddish dark circles caused by the visible muscle layer, grafting fat beneath the skin creates a color compensation effect between the yellow fat and the dark blue tone, resulting in a lighter appearance.

Number of fat grafting sessions​

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

The survival rate varies from person to person.

On average, fat grafting can produce satisfactory results with one to two sessions at intervals of about three months.

In the under-eye area, the survival rate of fat is higher than in other areas, so in many cases satisfactory results are achieved with just one session.

Therefore, a second session is performed only when necessary, and it is very rare to need a third session or beyond.

Fat engraftment and survival rate​

The survival rate of fat cells differs by facial area.

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

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

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

Areas with a low survival rate are the lips, while areas with the highest survival rate 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% remains after a few months.

The better the blood circulation in the area, the higher the fat survival rate. Since the area around the eyes has the best blood circulation on the face, fat grafting there has a relatively high survival rate compared with other areas.

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

However, since repeat procedures are sometimes done, it is possible to be satisfied if you think of it as being done about twice.

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 discarded 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 the bruising is usually mild enough to be covered with makeup, so there is no major problem with social life.

In some cases, if the swelling is significant, an anti-swelling injection will make it go down right away, so there is no need to worry too much about swelling.

Side effects of fat grafting

Side effects are limited to some swelling and bruising.

It can be said that there are no other side effects.

Some people worry that the contour under the eyes may become uneven or lumpy, but this is related to the operator’s experience and skill.

Therefore, under-eye fat grafting requires a lot of experience and know-how, so it is not a procedure just anyone can do.

Under-eye procedures can produce good results only when they are performed precisely and with an appropriate amount of fat distributed evenly.

Ultimately, how properly the procedure is performed by the operator is a key factor in whether it succeeds.

To this end, subcutaneous tunneling is performed and a micro fat grafting cannula is used so that there is no incision at all under the eyes, and the appropriate amount must be grafted precisely into the sunken area to achieve good results without side effects.

Also, if an awkward shape appears, the operator should be able to correct it easily and immediately.

Other treatment methods besides fat grafting

● Under-eye fat repositioning

Under-eye fat repositioning is not a procedure to correct dark circles.

It is one of the contour correction surgeries used to correct a bulging under-eye contour when the under-eye area is protruding.

If this procedure is performed when the under-eye area is not protruding, side effects such as under-eye hollowness or a step-like contour can easily occur.

Therefore, it is a surgical method that makes it very difficult to achieve the desired result properly.

Also, because it is performed through the conjunctiva, visibility is limited and the surgery often cannot be carried out properly, and there are not many people for whom fat repositioning is truly well suited.

● Method using filler

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

The purpose of fillers is not to create contour surgery.

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

They are often injected into aegyosal under the eyes or into sunken areas under the eyes, making the eye area look awkward or causing side effects.

Also, because fillers are transparent in color, when injected under the eyes they usually make the area look pale and awkward.

They can also create a bumpy shape or spread so that an unintended area protrudes.

Fillers should not be injected under the eyes; they are more appropriate for correcting fine wrinkles around the eyes.

Many people complain of awkward under-eye shapes or side effects after filler procedures under the eyes.

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

Fillers are better used only for fine wrinkles around the eyes, fine forehead wrinkles, fine wrinkles around the mouth, or small depressed scars.

● Vascular laser procedure

Dark circles can hardly be improved with lasers.

In the case of red dark circles, laser treatment is sometimes used to reduce redness. Although lasers can burn small capillaries within the skin layer and treat redness, they cannot change the red color under the eyes.

The reason is that the cause of the redness is not blood vessels in the skin, but the red orbicularis oculi muscle layer beneath the skin.

No matter how much laser is applied to the muscle layer, the redness will remain as long as the muscle layer is alive.

Other options, such as pigment lasers or resurfacing lasers that respond to black or blue tones, may be used, but the procedure is very limited. They may remove freckles or age spots, but it is difficult to resolve the overall dark appearance under the eyes.

● Cases where fat removal and fat grafting are done at the same time

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

At other clinics, there are cases where fat removal and fat grafting are recommended together, and fat grafting is done immediately after fat removal.

In such cases, satisfactory results are difficult to achieve.

At our clinic, we sometimes combine fat removal and fat grafting, but fat removal is done only when absolutely necessary, and it is not performed at the same time as fat grafting.

Usually, there is an interval of one month.

The reason is to wait for the result of the fat removal, then design accurately according to that result and finely adjust the amount of grafted fat based on the degree of hollowness.

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

In under-eye procedures that require great precision, such an act goes against the principle of the procedure.

In some cases, the eyes do not actually need fat removal, or the suggestion is even to remove fat while grafting a sunken eye shape.

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

If fat removal is done unconditionally without considering whether there is much or little fat under the eyes, that is an unreasonable procedure.

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

If there is protrusion, fat removal is needed, but if a person with almost no protrusion is advised to have fat removal, and at the same time fat grafting is also recommended, it should certainly be reconsidered.

There are many cases where people come to our clinic seeking correction after being dissatisfied with simultaneous fat removal and fat grafting at another clinic.

Such unreasonable procedures should not be performed in the under-eye area, which requires precision.

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

The photo above shows protruding orbital fat under the eyes with a depressed wrinkle line beneath it, so our clinic planned fat removal and fat grafting.

2. After the protruding area improved, but a depressed wrinkle line remained, planning fat grafting one month later

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

However, the depressed wrinkle line below the removed fat was not corrected.

Fat removal is surgery to correct under-eye protrusion, and it may not resolve the depressed wrinkle line under the eyes.

3. Appearance after fat grafting one month after fat removal

One month after fat removal, the depressed wrinkle line remained, so fat was grafted after accurately designing according to that and adjusting the amount of fat to be grafted.

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

After the result of the previous procedure is obtained, it should be confirmed and the plan should be made accurately before grafting.

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

Also, if a person who does not need fat removal at all is recommended both fat removal and grafting at the same time, that should also be reconsidered.​

Pre- and post-procedure care tips

● Pre-procedure care tips

1. Before surgery, receive sufficient consultation so that you understand what procedure is suitable for you, decide on the treatment method, and make a reservation for the desired date.

​2. Try to avoid surgery during the menstrual period.

If there is a lot of bleeding during surgery, it can interfere with the operation and may cause significant bruising.

3. Do not consume any alcohol the day before surgery.

Alcohol reduces the effect of anesthetic drugs, which can lead to problems with anesthesia during surgery.

4. It is best to quit smoking several days before, or at least reduce it as much as possible.

Nicotine interferes with blood circulation, slows wound healing, and in fat grafting can reduce the survival rate.

● Post-procedure care tips

◇ Micro fat grafting

• Day 2 after the procedure - The donor site is disinfected and you receive an injection to reduce swelling.

​* Day 4 after the procedure - Go to a jjimjilbang or sauna and sweat a little.

Sweating once or twice helps improve blood circulation and helps swelling and bruising subside more quickly.

• Day 7 after the procedure - The stitches at the donor site are removed and progress is checked.

If absorbable sutures were used, you do not necessarily need to come in.

<Precautions>

• Do not massage the grafted area so that the transplanted fat is not compressed.

Also, avoid making exaggerated facial expressions or broad eye-smiles.

• It is important not to apply any physical force or stimulation so that the grafted fat can survive well.

Be careful not to press on the fat grafting area even while sleeping.

Frequently asked questions about treatment for dark circles under the eyes

What is the best treatment for dark circles?

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

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

The appropriate treatment method differs from person to person depending on the cause and symptoms.

In some cases, fat grafting is necessary; in other cases, removing fat instead 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 shape.

I heard that micro fat grafting under the eyes often causes the under-eye area to become lumpy and has many side effects. Is that true?

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

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

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

Fat grafting is easy to do, but it is difficult to produce the right result.

Many people think fat grafting is easy, but it is definitely not.

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

The procedure method differs by clinic, and the results vary greatly depending on experience.

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

How is micro fat grafting under the eyes performed?

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

Therefore, performing it carelessly can cause side effects.

To prevent side effects, every step in the process must be carried out precisely according to principle.

For a good result, the fat should be harvested into as small particles as possible, all impurities completely removed, a tunneling space created in the treatment area so the fat can be evenly grafted, and then the proper amount should be delicately and evenly grafted.

A special grafting cannula fitted with a micro needle of about 1 mm in diameter is used for a very precise procedure.

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

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

A pigment laser is a laser that responds to red color, and it is mainly good for people with red capillary dilation 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 practical.

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

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

As long as the muscle is alive, the redness cannot change.

If the entire red muscle layer were burned away, the redness would disappear, but if the muscle were burned to the point of being destroyed, it would cause a major burn under the eyes and create a scar, so it is impossible and should not be done to remove 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 fat is removed to eliminate shadowing caused by a depressed wrinkle line below the protruding area, but if done incorrectly, it can easily have the opposite effect.

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

A sunken eye appearance creates shadows and looks darker.

Also, when fat is removed, the skin contracts and tightens, 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 red.

In most other cases, it can worsen dark circles, so caution is necessary.

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

The effects of under-eye fat grafting are fourfold.

It lifts depressed skin to eliminate shadowing, can lighten the skin tone by expanding the skin through fat grafting, improves fine wrinkles in the process, and can dilute dark reddish tones by laying down yellow fat.

Since symptoms differ from person to person, whether it will be effective can only be determined through an in-person examination.

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

If the expected result is judged to be less than satisfactory, 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 reduce and improve the current dark circles as much as possible.

Can micro fat grafting under the eyes be done at any clinic?

The under-eye area requires very precise work because the fat must be finely distributed in grain-of-rice-sized amounts beneath the thin skin.

Therefore, it is different from ordinary fat grafting in every stage, from selecting the donor site to purification and grafting.

Using a micro fat grafting cannula that leaves no scar and accurately and evenly grafting the proper amount determines the success of the procedure.

Therefore, without a great deal of experience and know-how, it is hard to expect good results.

Poorly done under-eye fat grafting can produce results worse than not doing it at all, so the procedure must be approached carefully.​

What do you think about using filler for the depressed wrinkle line under the eyes?

The skin under the eyes is very thin.

Unless the procedure is done with great precision, it is difficult to achieve satisfactory results, and any uneven bumpy texture after treatment should be avoided.

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

Another 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 display a natural shape, so if done precisely, uneven bumpiness is rarely seen.

It is possible when the operator performs the procedure accurately.

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

How much swelling and bruising occurs after micro fat grafting?

Swelling and bruising vary by person, but 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, it can only be covered with makeup until it fades.

You should undergo the procedure with bruising and swelling in mind.

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

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

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

Since the variables in survival rate depend on each person’s constitutional factors, it can only be determined about three months after the procedure how much of the fat has survived.

The decision on whether to do a second procedure is made after seeing the result three months later.

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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