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What is eyelid fat removal?

When the upper or lower eyelids are thick, it is usually caused by excess orbital fat.

In such cases, fat removal surgery is performed to improve the puffy-looking eyes into a normal contour.

Example of fat protrusion

Types of fat removal

① Upper eyelid fat removal

The upper eyelid contains two pockets of fat: one on the inner side of the eye and one on the outer side.

The outer fat accounts for about twice the volume of the inner fat, so it is usually the outer fat that is removed.

② Under-eye fat removal

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

Among them, the middle fat pocket is the largest, so the middle fat is removed.

If necessary, the outer and inner fat can also be removed, but removing too much fat can cause hollowness under the eyes. Therefore, removing one or two fat pockets is generally a reasonable method.

Anatomy of upper eyelid orbital fat

Effects of upper eyelid fat removal

① It can reduce morning swelling.

② It improves the appearance of swollen eyelids.

③ It relieves the feeling of heavy eyelids.

Precautions for upper eyelid fat removal

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

② When fat is removed from eyes with double eyelids, the double-eyelid line may become slightly larger.

③ Excessive fat removal can instead make the eyes look sunken, so care should be taken not to remove too much fat.

④ If the skin is loose and under-eye fat removal is performed, the skin may sag and wrinkles may increase.

Surgical process for upper eyelid fat removal

★ Steps 1~2: Design on the outer side of the eyelid -> inject local anesthetic

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 Inject local anesthetic. Since only a small amount is needed to achieve anesthesia, swelling from the anesthetic is minimal.

★ Steps 3~4: Make a 2 mm incision on the outer side of the eyelid -> pull out the orbital fat

③ Make an incision along the design line with a scalpel. The incision is only about 2~3 mm long, so scars are almost nonexistent. In eyelids with a double eyelid, the incision line passes through the double-eyelid line, so the scar is hidden and not visible.
④ Pull out the orbital fat. The fat is lodged in the orbital septum, so the orbital septum must be removed first, then the fat is pulled out until enough fat has been brought out.

★ Steps 5~6: Remove the fat with a scalpel -> cauterize the base of the fat with an electrocautery device

⑤ Hold the lower part of the protruded fat with a hemostatic forceps and excise it with a scalpel.
⑥ Cauterize the remaining fatty tissue with an electric coagulator so that bleeding does not occur from the base of the remaining fat. Good hemostasis is necessary to minimize swelling and bruising.

★ Step 7: One stitch with a fine thread

| ⑦ Only one stitch is placed using a thread as thin as a strand of hair. The stitch can be removed after 2~3 days. You can return to daily life immediately after surgery, and swelling and bruising are usually minimal. |

Examples of upper eyelid fat removal

Aftercare tips for upper eyelid fat removal

○ Use the cold compress packs provided by the hospital.

Do this for 3 days, 2 hours a day.

The cold compress can be done continuously for 2 hours, or split into 20~30 minute sessions.

It is usually convenient to do it before sleeping.

○ For the upper eyelid, apply the prescribed eye ointment twice a day. For under-eye fat removal, instill the antibiotic and anti-inflammatory eye drops prescribed by the hospital 3~4 times a day for 5 days.

○ For the upper eyelid, makeup and face washing are possible from the second day. For under-eye fat removal, washing the face and applying makeup are possible from the next day.

○ Postoperative swelling varies from person to person, but it usually subsides almost completely in about 7 days.

○ Upper eyelid fat removal requires stitch removal, but under-eye fat removal is closed with dissolvable thread, so there is no need to return for stitch removal.

What is under-eye fat removal?

The lower eyelid usually has three pockets of fat:

one on the inner side of the eye, one in the middle, and one on the outer side.

Among them, the middle fat pocket is the largest,

so the middle fat is removed, or, if necessary, the middle and inner fat may also be removed.

How many areas of fat are removed and how much is removed varies from person to person,

so it is important to remove an appropriate amount for each individual.

Excessive fat removal can cause hollowness under the eyes, so an appropriate amount should be removed after an accurate examination.

Anatomy of under-eye fat

Effects of under-eye fat removal

① It corrects a bulging under-eye contour caused by forward displacement of orbital fat.

② It improves frequent morning under-eye swelling.

③ It relieves the crease caused by hollowness beneath the under-eye bulge.

④ It reduces red dark circles under the eyes.

Precautions for under-eye fat removal

① Excessive fat removal can make the under-eye area hollow, so care should 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, there should be at least a 3-month interval before under-eye fat removal. If you have had LASEK, there should be at least a 1-month interval before under-eye fat removal.

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

Surgical process for under-eye fat removal

★ Steps 1~3: Mark the location of the fat with design ink -> under sedation, inject local anesthetic into the conjunctiva -> make a conjunctival incision with an electric coagulator or laser

① Mark the location of the fat with design ink. Usually the inner and middle areas are marked, and in some cases only the middle area is marked. Depending on the distribution and amount of fat, the areas to be removed are determined and designed.
② Anesthesia is performed with local anesthetic under sedation, so the patient is asleep and anesthesia can be administered without any pain.
③ To protect the eyeball, a corneal protector is worn and the conjunctiva is incised with an electric coagulator. Laser may also be used, but because laser has weaker hemostatic effects, bleeding can be heavy during surgery, so an electric cautery device is generally used more often. The electric coagulator has the advantage of reducing bleeding and minimizing swelling and bruising.

★ Steps 4~6: Pull the exposed fat outward -> cauterize with an electric coagulator -> close the conjunctiva with dissolvable thread

4. After the incision, when the fat is exposed, it is pulled outward with forceps so that only the amount to be removed comes out. Excessive fat removal can cause hollowness and wrinkles under the eyes, so it is appropriate to remove only the amount that can be pulled out.
5. For definite hemostasis, bleeding is controlled with a bloodless-surgery device, the electric coagulator. If hemostasis is insufficient, bleeding may occur from the inside after surgery, causing significant swelling and bruising, so proper hemostasis is important.
6. After all the fat has been removed, the incision is closed with dissolvable thread. The dissolvable thread disappears over 7~15 days, so there is no need to return later for stitch removal. Contact lens wear is also possible from the day after surgery.

★ Step 7: There is almost no swelling or bruising immediately after the procedure.

| The surgery takes about 20~30 minutes, and if it ends without bleeding because hemostasis is good, swelling and bruising are usually minimal. Antibiotic and anti-inflammatory eye drops are used after surgery to prevent swelling and inflammation. |

Examples of under-eye fat removal

Aftercare tips after under-eye fat removal

○ Use the cold compress packs provided by the hospital.

Do this for 3 days, 2 hours a day.

The cold compress can be done continuously for 2 hours, or split into 20~30 minute sessions.

It is usually convenient to do it before sleeping.

○ In the case of under-eye fat removal, return to the hospital on the 7th day after surgery for follow-up.

○ Postoperative swelling varies from person to person, but it usually subsides almost completely in about 7 days.

Dr. Column

Knowledge you should know correctly about under-eye fat removal

This is when fat removal is performed with a laser.

There are hospitals that perform fat removal with a laser, but there are facts you should know.

Some people mistakenly think that lasers are a universal and best surgical method.

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

The heat generated by the laser naturally stops bleeding in fine capillaries, but in the case of slightly larger blood vessels, hemostasis does not occur, so if surgery is performed only with a laser, the bleeding prevents the surgery from being completed at all.

If surgery is to be done with a laser, it must be performed with an electric coagulator.

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

There is no reason at all to perform surgery in such a complicated way.

If surgery is performed from the beginning with an electric coagulator,

hemostasis is properly achieved and the operation can proceed quickly.

Despite several disadvantages, there are hospitals that use lasers.

It is simply to gain promotional effect for the hospital through the word “laser.”

By using the word laser, it gives the impression that the surgery will be better,

which is intended to attract customers.

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

In the case of pigment lasers used to remove nevus of Ota or tattoos,

they can cost tens of millions of won, but a carbon dioxide laser is one of the least expensive lasers,

and is usually used to remove moles, freckles, and age spots.

Just because a hospital has a carbon dioxide laser

does not mean it has especially expensive equipment.

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

We also have a carbon dioxide laser here,

and mainly use it only to remove moles and age spots.

We do not use it for surgery.

Second, there are cases where fat removal plastic surgery is performed at a dermatology clinic.

There are cases where plastic surgery is performed at a dermatology clinic rather than a plastic surgery clinic.

Dermatology is the department that treats skin diseases.

Dermatology is a field completely unrelated to plastic surgery.

Sometimes people confuse dermatology and plastic surgery.

Dermatology can be thought of as similar to internal medicine.

Internal medicine 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 internal medicine doctor holding a scalpel.

After fat removal at a dermatology clinic, people often come to our clinic for correction due to excessive fat removal and side effects.

In such cases, we correct it with micro fat grafting,

but before that, such side effects should not be created in the first place.

As the saying goes, “medicine is for pharmacists, treatment is for doctors,”

plastic surgery should be entrusted to a plastic surgery specialist.

Lastly, there is fat removal aimed at improving dark circles.

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

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

In most cases, when fat is removed, the skin contracts and the skin color changes,

but if too much fat is removed, the under-eye area can become hollow and look even darker.

The goal of fat removal is to remove an appropriate amount of fat

to create a smooth eye contour.

The change in color after fat removal varies by person,

but it is not common for the area to become brighter.

If the skin under the eyes is thin and the red muscle layer beneath shows through,

causing a reddish appearance, fat removal can reduce the redness.

However, in other cases, the color may become darker,

so this should be kept in mind during surgery.

The change in color after fat removal should be predicted in advance before surgery,

so that problems do not occur afterward.

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