[Duhan Plastic Surgery Dark Circle Surgery Method] - [No-Scar Under-Eye Fat Removal]

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Dark circles are

sunken, under-eye wrinkles, protruding, dark in color, blue veins, and more

There are various symptoms.

The correct surgical method must be applied according to the symptoms.

DUHAN DARK CIRCLE CLINIC

Under-eye fat removal

DUHAN DARK CIRCLE CLINIC

The relationship between under-eye orbital fat and dark circles

The fat under the eyes protrudes and at the same time creates shadowed wrinkles beneath it.

When the fat protrudes in a state where the skin is thin, the skin color under the eyes usually appears red.

This is because the red orbicularis oculi muscle layer directly beneath the skin becomes visible through the skin.

The more the fat pushes forward, the puffier the under-eye area becomes, the thinner the skin gets, and the more visible the reddish muscle layer beneath the skin becomes.

Fat protrusion creates red dark circles and also produces a shadow effect from the sunken wrinkle line beneath it.

Anatomical illustration of the under-eye orbital fat and dark circles

The red dark circles above are created as the skin expands and becomes thinner due to the protrusion of orbital fat, allowing the red orbicularis oculi muscle beneath the skin to show through.

Because the orbicularis oculi muscle beneath the skin is what causes red dark circles to appear visible, the way to correct this is to thicken the skin so that the orbicularis oculi muscle does not show through, and one way to do this is to remove the under-eye orbital fat.

In the case above, after orbital fat removal, the skin contracts and shrinks, which causes the skin to become thicker so that the orbicularis oculi muscle beneath it appears less visible.​

As a result, the red dark circles can be alleviated.

Causes of under-eye orbital fat protrusion

① When fat protrudes forward due to aging

② When the volume of fat increases

③ Constitutional factors

④ Cases caused by trauma to the orbital bone

⑤ When the septum surrounding the orbital fat becomes thinner or weaker

Correction methods for under-eye orbital fat protrusion

① Scar-free fat removal through the conjunctiva

② Lower blepharoplasty through an external skin incision

③ Micro fat grafting beneath the protruding area

④ Fat-dissolving injection therapy

1. Scar-free fat removal through the conjunctiva

■ Advantages of scar-free fat removal through the conjunctiva

There is no need to worry about scars.
You can return to daily life immediately.
The procedure is simple and inexpensive.
There is almost no swelling or bruising.

■ Disadvantages of scar-free fat removal through the conjunctiva

If too much fat is removed due to the practitioner's lack of experience, the under-eye area may actually become sunken or the dark circles may worsen.
If too little is removed due to the practitioner's lack of experience, the protruding area may not be properly corrected.
If fat is removed while fine wrinkles are present, the wrinkle lines may become more pronounced.
It is effective for red dark circles, but if fat is removed from black dark circles, the dark circles may worsen.

2. Lower blepharoplasty through an external skin incision

Lower blepharoplasty can also involve making an incision in the skin under the eyes to remove both skin and fat at the same time.

This surgical method is used when fat removal alone does not adequately correct the contour and when more wrinkles are likely to form due to sagging skin. By pulling the skin upward, excising the excess skin, stitching it closed, and removing fat, both sagging skin and under-eye protrusion are improved at the same time.

3. Micro fat grafting beneath the protruding area when protrusion is mild

This method is used when under-eye protrusion is slight and the sunken wrinkle line beneath the protrusion is distinct. Rather than removing fat, fat is grafted below to cover the protruding area.

In other words, when removing the protruding area itself may instead cause under-eye hollowing and there seems to be little room for improvement in the dark circles, fat is grafted below to eliminate the shadow under the eyes and cover the protruding area with fat grafting, making the protruding area visually disappear.

4. Fat-dissolving injection therapy

This is a method of dissolving fat with an injectable medication. It has only recently begun to be performed, but the results are difficult to predict and the effectiveness is low, so multiple sessions are needed. If the medication spreads beyond the treatment area, the appearance of the eyes may become even more unnatural, so caution is required.

Indications for under-eye fat removal

① Correcting a puffy under-eye contour caused by forward displacement of orbital fat

② When you want fat removed only without lower blepharoplasty

③ Eyes that tend to swell in the morning

④ When wrinkle lines are visible around the protruding under-eye area

Effects of under-eye fat removal

① It can correct swollen-looking eyelids.

② In the case of under-eye fat removal, under-eye wrinkles are corrected along with restoration to a smoother eye area.

③ There is no scar and the result looks natural.

④ There is almost no bruising or swelling, so daily life can be resumed immediately.

Painless anesthesia under-eye fat removal surgery process

Painless anesthesia is usually also called sleep anesthesia, and before local anesthesia is administered, an IV is placed in the arm.

Then, without even realizing it, you enter a sleep state, and at that time local anesthesia is injected into the surgical area.

There is no pain at all while the local anesthetic is being administered.

Once the anesthesia is complete, you wake up from the sleep state, so the patient does not remember having been anesthetized, and the anesthesia is over without the patient realizing it.

The surgery is performed while the patient is awake.

The difference from general anesthesia, in which anesthetic gas is continuously administered through the airway during surgery to induce a comatose state, is whether or not the patient remains conscious during the operation.

Sometimes the sleep state is maintained throughout the surgery, but this is still clearly different from general anesthesia.

① Design - Mark the location for fat removal with design ink.

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

The design is determined by identifying which area’s fat should be removed based on the distribution and amount of fat.

② Painless anesthesia, local anesthesia - Anesthesia is performed under painless sleep anesthesia with local anesthesia to the conjunctiva.

Anesthesia is induced with sleep anesthesia.

Then local anesthesia is administered again, but since the patient is already asleep, no pain can be felt at all.

③ Conjunctival incision with an electrocautery device or laser - The conjunctiva is removed while wearing a corneal protector.

To protect the eye, a corneal protector is worn and the conjunctiva is incised with an electric coagulator.

A laser may also be used, but because lasers have weaker hemostatic effects, bleeding during surgery can be significant, so in general an electric coagulator is used more often.

An electric coagulator minimizes bleeding and can reduce swelling and bruising.

④ Pull out the fat, excise it, and stop the bleeding - The fat is pulled out, excised, and then hemostasis is performed.

After the incision, when the fat is exposed, it is grasped with forceps and pulled outward so that only the amount needed for removal comes out.

Excessive fat removal causes under-eye hollowing and wrinkles, so it is appropriate to remove only the amount that comes out when pulled.

For definite hemostasis, bleeding is controlled with a bloodless surgical device, the electric coagulator.

⑤ Suturing and completion of fat removal surgery - The surgery is finished by suturing with dissolvable thread.

After all the fat has been removed, the area is sutured with dissolvable thread.

The dissolvable thread dissolves and disappears within 7 to 15 days, so there is no need to return later to have the stitches removed.

The surgery takes about 20 to 30 minutes, and when it is completed quickly with good hemostasis and without bleeding, it is common for there to be almost no swelling or bruising.

After surgery, antibiotic and anti-inflammatory eye drops are instilled to prevent swelling and inflammation.

Care instructions after under-eye fat removal surgery

① After fat removal, use the cold compress pack provided by the hospital for about 3 days.

② On the day of surgery, sleep with your head raised about 30 degrees to reduce bruising and swelling.

③ To reduce swelling and bruising, remain seated rather than lying down as much as possible on the day of surgery.

④ Washing your face and applying makeup are possible from the next day.

⑤ Contact lenses may be worn starting the day after surgery.

⑥ Instill the eye drops prescribed by the hospital for about one week.

⑦ Since the conjunctiva is sutured with dissolvable thread, there is no need to come in for stitch removal.

⑧ Swelling and bruising are only mild and will subside almost completely in about a week.

Precautions for under-eye fat removal

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

② If under-eye fat is removed when the skin is loose, the skin may sag and more wrinkles may form.

③ If you have had LASIK, under-eye fat removal should be performed at least 3 months later, and if you have had LASEK, it should be performed at least 1 month later.

④ Under-eye fat removal may worsen dark circles in some cases, so if there is a risk of worsening dark circles, the procedure should not be performed.

Side effects of under-eye fat removal

The most common side effects include under-eye hollowing due to excessive fat removal caused by inaccurate measurement of the fat amount because of the surgeon's lack of experience, more fine wrinkles than before surgery, and the appearance or worsening of dark circles.

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

To avoid side effects, it is important to make an accurate diagnosis before surgery, determine the indications for fat removal carefully, and remove an 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 from a plastic surgeon who is not a specialist.

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 little color change, the color may become slightly darker, or the color may become lighter.

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

Conversely, if the color is red, the redness may decrease.

Depending on the skin type and current color, the color changes after fat removal should be predicted in advance and handled accordingly.

If fat removal is performed for the purpose of improving dark circles, it may actually worsen them, so the indications for the procedure must be carefully determined.

When fat is removed for the purpose of improving dark circles, additional fat grafting may later be needed beneath the area where the fat was removed.

Knowledge you should understand correctly about under-eye fat removal

1. When fat removal is performed with a laser

There are clinics that perform fat removal with lasers, but there is something you need to know.

Even if most clinics have lasers, they do not perform surgery with lasers.

Some people mistakenly think of lasers as a universal and best surgical method.

When cutting during under-eye fat removal with a laser, the problem is that there is a lot of bleeding after the incision.

The heat generated by the laser can stop bleeding in fine capillaries on its own, but for slightly larger blood vessels, hemostasis does not occur, so if surgery is performed with only a laser, the operation cannot be done at all because of bleeding.

To operate with a laser, surgery must be performed with an electric coagulator.

If there is bleeding, the laser must be stopped and surgery continued while controlling hemostasis with an electric coagulator.

There is no reason at all to perform surgery this way.

If surgery is performed from the beginning with an electric coagulator, proper hemostasis is achieved and the operation can proceed quickly.

Despite the various drawbacks, there are clinics that still use lasers.

It is only to gain promotional effect by using the word “laser.”

By using the laser, they try to give the impression that the surgery will go better and encourage patients to choose the procedure.

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

Pigment lasers used to remove Ota nevus or tattoos can cost tens of millions of won, but a carbon dioxide laser is one of the least expensive lasers and is generally used to remove moles, freckles, and age spots.

Having a carbon dioxide laser does not mean that the clinic has especially expensive equipment.

It should be understood as basic equipment that all plastic surgery and dermatology clinics have.

Our clinic also has a carbon dioxide laser and mainly uses it only for removing moles and age spots.

It is not used for surgery.

2. When fat removal plastic surgery is performed in dermatology clinics

Sometimes plastic surgery is performed at a dermatology clinic rather than a plastic surgery clinic.

This is something to think about carefully.

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

Dermatology is a field that has no connection with plastic surgery.

Sometimes people confuse dermatology and plastic surgery.

Dermatology is similar to internal medicine.

Internal medicine treats colds and internal bodily diseases 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.

There are frequent cases where patients come to our clinic for correction after excessive fat removal and side effects from fat removal at a dermatology clinic.

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

As the saying goes, medicine belongs to pharmacists and treatment belongs to doctors, plastic surgery should be entrusted to a specialist in plastic surgery.

3. Fat removal for improving dark circles

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

It is not a surgery whose primary goal is to change the color under the eyes.

In most cases, fat removal changes the skin color due to skin contraction, but if too much fat is removed, the under-eye area can become sunken and look darker.

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

Color changes after fat removal vary from person to person, but it is not common for the color to become brighter.

If the under-eye skin is thin and the red muscle layer beneath the eyes shows through, giving a reddish appearance, removing the fat can reduce the redness.

However, in other cases, the color may become darker, so this must be kept in mind during surgery.

Surgery should be performed after predicting the color changes following fat removal in advance so that problems do not arise after the operation.

Before under-eye fat removal

First, after fat removal,

we predict in advance the changes in under-eye color and skin elasticity

and then decide whether to proceed with surgery.

Also, if under-eye fat removal is performed appropriately,

wrinkles under the eyes will not form or appear hollow.

Under-eye fat removal is performed as a scar-free surgery through the conjunctiva.

An incision of about 3 mm is made through the conjunctiva and the excess orbital fat is removed.

Anesthesia is performed under painless sleep anesthesia with local anesthesia.

Therefore, you do not need to worry about pain.

The surgery takes about 30 to 40 minutes,

and you can return to daily life immediately.

You can go home right after the surgery.

It varies by person, but swelling and bruising are not severe.

The stitches are closed with dissolvable thread, so you do not need to come back to have them removed.

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