[Du-han Plastic Surgery Ophthalmic Surgery] - [Eyelid Fat Removal]

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#Upper eyelid fat removal surgery #Upper blepharoplasty #Eyelid fat #Eye fat #Upper eyelid fat #Fat grafting for sunken eyes #Ptosis surgery #Upper eyelid fat grafting

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#Upper blepharoplasty lift #Under-eye fat removal #Under-eye fat repositioning #Under-eye fat repositioning surgery #Under-eye fat #Autologous under-eye fat #Middle-aged drooping eyes #One-sided drooping eye

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Eyelid fat removal + under-eye fat removal

What is eyelid fat removal?

The eyelids contain a structure called "orbital fat."

If there is an appropriate amount of orbital fat, it helps maintain the contour of the eyelids, protects the eyeball, and acts as a lubricant for eyelid movement. But if there is too much, the lower or upper eyelids may protrude and look puffy.

Removing this unnecessary fat is eyelid fat removal.

Types of fat removal

1. Under-eye fat removal

The lower eyelid usually has three fat pads: one on the inner side of the eye, one in the middle, and one on the outer side.

Among these, the middle fat pad is the largest, so the middle fat is usually removed, and depending on the case, the inner fat may also be removed.

How much fat to remove and from which areas varies from person to person, so it is important to remove the appropriate amount for each individual.

Removing too much fat can cause under-eye hollowness, so it is important to remove only the proper amount after an accurate examination.

Indications for under-eye fat removal

A protruding under-eye appearance caused by forward displacement of orbital fat	Eyes that easily swell in the morning
When wrinkle lines are visible around the protruding under-eye area	When there is a reddish dark circle under the eyes

2. Upper eyelid fat removal

The upper eyelid usually has two fat pads: one on the inner side of the eye and one on the outer side.

The outer fat pad is about twice the volume of the inner one, so in most cases the usual fat-removal method is to remove the outer fat pad.

Indications for upper eyelid fat-removal procedures

Eyes that look puffy in the eyelids	Eyes that easily swell in the morning
When the eyelids feel heavy	When you want to remove only fat without affecting the double eyelid line

Effects of fat removal

1. It can correct puffy-looking eyelids.

2. In the case of under-eye fat removal, it can restore a smoother eye shape and correct the wrinkled lines caused by under-eye hollowness.

3. It can correct reddish dark circles under the eyes.

4. It can restore a more youthful eye shape.

Anatomy of upper eyelid orbital fat

Upper eyelid fat removal surgery process

1. Mark the outer side of the eyelid with a design pen.

If there is a double eyelid, the design is made along the double eyelid line.

2. Local anesthetic is injected.

Even a small amount is enough to numb the area, so there is little swelling from the anesthetic.

3. An incision is made with a scalpel along the design line.

The incision is only about 2 to 3 mm long, so there is almost no visible scar.

In the case of an eyelid with a double eyelid, the incision line passes through the double eyelid line, so the scar is hidden and not visible.

4. The orbital fat is pulled and brought out.

The fat is accumulated in the orbital septum, so the orbital septum must be removed first, and then the fat is pulled out so that enough fat comes out.

5. The lower part of the protruding fat is grasped with hemostatic forceps and excised with a scalpel.

6. The remaining fat tissue is cauterized with an electric coagulator to prevent bleeding from the base of the remaining fat.

Good hemostasis is necessary to prevent swelling and bruising.

7. One stitch is placed with a very fine thread about the thickness of a hair.

The thread can be removed after 2 to 3 days.

You can return to daily life immediately after surgery, and there is usually little swelling or bruising.

Before and after upper eyelid fat removal

Post-procedure care after upper eyelid fat removal

○ After fat removal, use the cold compress pack provided by the hospital for about 3 days.

○ Remove the stitches on the second day after surgery.

○ Washing your face and applying makeup are possible starting the day after surgery.

○ Swelling and bruising are mild, so you can resume daily life right away.

Precautions for upper eyelid fat removal

1. If the skin or orbicularis oculi muscle is thick and the eyelids look swollen, the effect of fat removal may be minimal.

2. When fat is removed from an eye with a double eyelid, the double eyelid line may become slightly larger.

3. Excessive fat removal can make the eyes look sunken, so do not remove too much fat.

4. If the skin or orbicularis oculi muscle of the upper eyelid is thick and makes the eyes look swollen, the effect of fat removal may be minimal.

5. In eyes that have undergone double eyelid surgery, upper eyelid fat removal is more difficult.

Under-eye fat anatomy

Under-eye fat removal surgery process

1. The location of the fat is marked with design ink. In most cases, the inner and middle areas are marked, and in some cases only the middle area is marked.

The area from which fat will be removed is determined according to the distribution and amount of fat.

2. Anesthesia is performed under painless sedation, and local anesthesia is applied to the conjunctiva. Since the anesthetic is given while the patient is asleep, anesthesia can be done without any pain.

3. To protect the eyeball, a corneal shield is worn, and an incision is made in the conjunctiva with an electric coagulator.

In some cases, a laser is used, but because lasers have poorer hemostatic effect and can cause severe bleeding during surgery, electric coagulators are generally used more often.

An electric coagulator reduces bleeding and can minimize swelling and bruising.

4. After the incision, when the fat is exposed, it is pulled out with forceps so that only the amount to be removed comes out.

Excessive fat removal can cause under-eye hollowness and wrinkles, so it is appropriate to remove only what comes out when it is pulled.

5. For sure hemostasis, bleeding is controlled with the bloodless surgery device, an electric coagulator.

If hemostasis is insufficient, internal bleeding may occur after surgery, causing significant swelling and bruising, so good hemostasis is important.

6. After all the fat is removed, the incision is closed with dissolvable thread.

The dissolvable thread melts away within 7 to 15 days, so there is no need to come back to remove stitches later.

Contact lenses can be worn starting the day after surgery.

7. The surgery takes about 20 to 30 minutes, and if it finishes quickly with good hemostasis and no bleeding, it is common to have little swelling or bruising.

Antibiotic and anti-inflammatory eye drops are given after surgery to prevent swelling and inflammation.

Before and after under-eye fat removal

Post-procedure care after under-eye fat removal

○ After fat removal, use the cold compress pack provided by the hospital for about 3 days.

○ On the day of surgery, sleep with your head raised about 30 degrees to reduce bruising and swelling.

○ On the day of surgery, stay seated as much as possible and avoid lying down to reduce swelling and bruising.

○ Washing your face and applying makeup are possible starting the next day.

○ Contact lenses may be worn starting the day after surgery.

○ Use the eye drops prescribed by the hospital for about one week.

○ The conjunctiva is closed with dissolvable thread, so there is no separate stitch removal.

○ Swelling and bruising are mild and usually subside almost completely within about a week.

Precautions for under-eye fat removal

1. Excessive fat removal can make the under-eye area sunken, so care must be taken not to remove too much fat.

2. If the skin is loose and under-eye fat removal is performed, the skin may sag and wrinkles may increase.

3. If you have had LASIK, wait at least 3 months before undergoing under-eye fat removal. If you have had LASEK, wait at least 1 month before undergoing under-eye fat removal.

4. Under-eye fat removal may worsen dark circles in some cases, so if dark circles could worsen, the procedure should not be performed.

Side effects of under-eye fat removal

The most common side effects are under-eye hollowness caused by excessive fat removal due to the surgeon's lack of experience in measuring the amount of fat, increased fine wrinkles compared to before surgery, and the appearance or worsening of dark circles.

If under-eye hollowness occurs after excessive fat removal, it can be corrected and restored with micro fat grafting.

To prevent side effects, it is important to make a precise diagnosis before surgery, identify the indications for fat removal, and remove the appropriate amount of fat.

If the skin lacks elasticity and is prone to fine wrinkles, or if dark circles may worsen or appear, fat removal should not be performed.

To avoid side effects, the rule is not to undergo surgery by a non-specialist plastic surgeon.

Color changes under the eyes after fat removal

Depending on the skin type under the eyes, there are roughly three kinds of color changes after fat removal.

There may be almost no color change, the color may become slightly darker, or it may become lighter.

If there are dark circles under the eyes, the color often becomes darker after fat removal.

On the other hand, if the color is reddish, the redness may decrease.

The color change after fat removal should be predicted and managed in advance according to skin type and the current color.

When fat removal is performed to improve dark circles, it may actually worsen them, so the indications for the procedure must be carefully assessed.

In some cases, when fat is removed for the purpose of improving dark circles, additional fat grafting may later be needed below the removed area.

Frequently asked questions and answers about under-eye fat removal

Q. What is the best method for under-eye fat removal?

A. Under-eye fat removal does not involve making an incision in the skin.

If an external incision is made, a scar will remain, so a scarless procedure through the conjunctiva is usually performed.

Q. How much swelling and bruising occurs after fat removal?

A. There will be a little swelling and bruising, but they will almost disappear after about a week.

Q. Do the stitches need to be removed?

A. Since the fat is removed through an incision in the conjunctiva and then closed with dissolvable thread, there is no need to remove stitches.

Q. Does the fat grow back?

A. Fat that has been removed once does not regenerate.

Fat removal has a permanent effect.

Q. What is the best method for under-eye fat removal?

A. Under-eye fat removal does not involve making an incision in the skin.

If an external incision is made, a scar will remain, so a scarless procedure through the conjunctiva is usually performed.

Q. How much swelling and bruising occurs after fat removal?

A. There will be a little swelling and bruising, but they will almost disappear after about a week.

Q. Do the stitches need to be removed?

A. Since the fat is removed through an incision in the conjunctiva and then closed with dissolvable thread, there is no need to remove stitches.

Q. Does the fat grow back?

A. Fat that has been removed once does not regenerate.

Fat removal has a permanent effect.

Correction through under-eye fat repositioning

Instead of removing the orbital fat under the eyes, this refers to moving the fat and spreading it below the protruding area.

This is a method intended to correct both the protruding area and the sunken area at the same time.

It was devised to compensate for the drawback that fat removal can address the protruding area but cannot address the sunken area as well.

Problems with under-eye fat repositioning

The problem with under-eye fat repositioning is that it is difficult to achieve the desired result properly.

Because the surgery is performed through the conjunctiva, visibility is limited and the operation is not done properly, and there are not many people whose anatomy is ideal for getting good results from fat repositioning.

As a simple example, if there is land with a hill and a hollow, and the goal is to remove soil from the hill to fill the hollow and make the whole area flat, if the hill is not very large, then even after removing all the soil from the hill, there still may not be enough to fill the hollow, and after filling it, the hill may actually become a hollow.

This means that when there is not much fat and it is forcibly pulled and repositioned, the previously protruding area may instead become sunken.

In another case, the hollow is larger than the hill, so even after removing all the soil from the hill to fill the hollow, the depth of the hollow decreases a little but still remains a hollow.

This means that even after pulling and repositioning a small amount of fat, the sunken area is not well corrected and remains sunken.

In yet another case, the hill is large, so even after filling the hollow completely, the hill only becomes slightly smaller and still remains a hill.

This means that there is so much protruding fat that even after repositioning, fat remains and the under-eye bulge is still there.

Four unsatisfactory outcomes of fat repositioning

1. When there is not enough fat, the protruding area where the fat used to be becomes sunken after fat repositioning.

2. When there is a large amount of fat, the original protruding area still appears protruded even after fat repositioning.

3. After fat repositioning, the original sunken area appears protruded instead.

4. When there is only a small amount of fat, the original sunken area is not properly filled even after fat repositioning and still appears sunken and shadowed.

Therefore, when performing fat repositioning, surgery must be done by carefully assessing the appropriate shape and indications in order to achieve satisfactory results. If the procedure is not indicated, fat repositioning may end up being a half-baked operation that achieves neither result well.

Also, because more tissue must be dissected than in fat removal, swelling and bruising are much more severe.

If the procedure is not suitable for the indication, fat removal can provide a more definite result than fat repositioning, and if necessary, micro fat grafting can later be performed to fill the sunken area after fat removal.

Knowledge you should understand correctly about under-eye fat removal

When fat removal is performed with a laser

There are clinics that perform fat removal with a laser, but there is something you should know.

Some people mistakenly think that a laser is the best all-purpose surgical method.

The problem with laser incision during under-eye fat removal is that there can be a lot of bleeding after the incision.

Laser-generated heat can stop bleeding from fine capillaries on its own, but with slightly larger blood vessels, hemostasis does not occur, so if surgery is performed only with a laser, the operation may not proceed at all because of bleeding.

If you are going to perform the surgery with a laser, you need to use an electric coagulator.

If there is bleeding, you must stop using the laser and proceed while controlling bleeding with an electric coagulator.

There is absolutely no reason to perform surgery this way.

If you use an electric coagulator from the beginning, hemostasis is properly controlled and the surgery can proceed faster.

Despite the various disadvantages, some clinics still use lasers.

It is only to gain publicity for the clinic through the word "laser."

By using the word laser, they try to give the impression that the surgery will go better and encourage people to seek treatment.

The laser used for fat removal is a carbon dioxide laser for incision.

In the case of pigment lasers used to remove Ota nevus or tattoos, the price can reach tens of millions of won, but a carbon dioxide laser is the least expensive type of laser and is usually used to remove moles, freckles, and age spots.

Just because a clinic has a carbon dioxide laser does not mean it has especially expensive equipment.

You can think of it as basic equipment that all plastic surgery and dermatology clinics have.

Our clinic also has a carbon dioxide laser, and we mainly use it only to remove moles and age spots.

We do not use it for surgery.

When fat removal plastic surgery is performed in dermatology clinics

Sometimes plastic surgery is performed in dermatology clinics rather than in plastic surgery clinics.

This is something to think carefully about.

As you know, dermatology is the department that treats skin conditions such as acne, atopic dermatitis, athlete's foot, and eczema.

Dermatology is a field that has no direct connection to plastic surgery.

Sometimes people confuse dermatology and plastic surgery.

Dermatology can be thought of as similar to internal medicine.

Internal medicine is the department that treats colds and internal diseases of the body with medication, and dermatology also treats skin diseases with medication.

A dermatologist holding a scalpel and performing plastic surgery is no different from an internist holding a scalpel.

We often see patients come to our clinic for correction after excessive fat removal and side effects from fat removal performed in dermatology clinics.

In such cases, we correct it again with micro fat grafting, but such side effects should not be created in the first place.

As the saying goes, "Medicine is for pharmacists, and treatment is for doctors," plastic surgery should be left to a plastic surgery specialist.

It should not happen that a doctor from another department with limited experience in plastic surgery performs the procedure and the patient suffers side effects.

Fat removal to improve dark circles

The main purpose of under-eye fat removal surgery is to correct the protruding under-eye contour.

It is not primarily a surgery aimed at the color of the under-eye area.

In most cases, when fat is removed, the skin color changes due to skin contraction. If too much fat is removed, the under-eye area can become hollow and look even darker.

The goal of fat removal is to create a flat eye shape by removing an appropriate amount of fat.

The color change after fat removal varies from person to person, but it does not often become brighter.

If the under-eye skin is thin and the red muscle layer underneath shows through, giving a reddish tone, removing fat may reduce the redness after surgery.

However, in other cases, the color may become darker, so this must be kept in mind when performing the procedure.

To avoid problems after surgery, the color change after fat removal must be predicted in advance before surgery.

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