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Upper eyelid hollowing

A soft, beautiful facial contour~

Create it with micro fat grafting!

Micro fat grafting for sunken eyelids

Micro fat grafting for the upper eyelids is a procedure used when the eyelids are sunken, making you look tired or older. In addition to restoring hollowed eyelids cosmetically, it also helps functionally by making it easier to open the eyes.

Indications for micro fat grafting of the upper eyelids

① Restoring sunken eyes to a fuller, more voluminous appearance

② When the cheekbones appear relatively more prominent

③ Improving discomfort or fatigue when opening the eyes

④ In cases of exophthalmos, easing the symptoms of eye protrusion

Examples of upper eyelid hollowing

Anatomy of orbital fat in the upper eyelid

The role of orbital fat

① It gives the eyelid contour a fuller and softer look.

② It protects the eyeball from external impact.

③ It acts as a lubricant so the levator palpebrae superioris muscle (the eyelid-lifting muscle) can move smoothly.

Effects of upper eyelid fat grafting

♥ Cosmetic aspect

Correction of hollow areas for a softer, younger-looking eye contour

♥ Functional aspect

By smoothing the movement of the levator palpebrae superioris muscle that opens the eyes, it reduces eyelid fatigue.

Placement of micro fat grafting in the upper eyelid

The goal of upper eyelid fat grafting is to satisfy both cosmetic and functional purposes.

For this, it is absolutely important to graft the right amount of fat into the exact correct location.

The most accurate grafting location is where the orbital fat is located, and the newly grafted fat should blend with the existing fat in this area to achieve a good result.

However, if it is grafted incorrectly into the orbicularis muscle layer, the eyelids can become uneven and, rather than helping, the eyelids may feel heavier and opening the eyes may become even more uncomfortable.

Therefore, upper eyelid fat grafting must be performed delicately with precise anatomical knowledge in order to achieve the desired result.

How upper eyelid fat grafting is performed

① Fat is collected from areas where you have a lot of fat, such as the lower abdomen, waist, or thighs.

Because the amount of fat needed for eyelid fat grafting is not very large, the lower abdomen is usually the preferred harvest site.

• Since local anesthesia (sedation analgesia) is used, there is no pain at all.

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

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

③ After centrifugation, the fat undergoes the next purification step to remove oil.

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

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

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

⑤ A micro fat grafting cannula is inserted along the planned line of the eyelid for grafting.

At our clinic, we use our own micro needle (micro grafting cannula) developed in-house.

The micro needle is a special grafting cannula used only at our clinic, enabling ultra-precise grafting.

The fat is grafted into the orbital fat layer, creating a soft contour and a high take rate.

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

Examples of upper eyelid fat grafting procedures

2D planar fat grafting in the upper eyelid

Fat grafting for the upper eyelid (upper blepharoplasty area) should be performed as 2D planar fat grafting.

If fat is grafted under the skin, problems such as heavier eyelids and uneven skin texture may occur.

To avoid these side effects, the fat must be grafted precisely between the orbicularis muscle and the levator palpebrae superioris muscle, which requires accurate anatomical knowledge and extensive experience.

When fat is grafted into the correct location in the 2D orbital fat layer, the upper eyelid fat grafting is complete both functionally and aesthetically.

Recovery period after eyelid fat grafting

In most cases, normal activities are possible right away.

There will be some swelling and bruising, but it is usually mild enough to be covered with makeup, so it does not cause major problems in daily life.

However, swelling and bruising vary from person to person, so results are not identical in every case. On average, severe swelling and bruising do not occur, and it is common for the area to look natural after about a week.

Number of upper eyelid fat grafting procedures

Eyelid fat grafting tends to have a higher take rate than other areas.

Usually, one procedure is sufficient, and in some cases two procedures are enough to achieve satisfactory results.

The interval between procedures is between 3 and 10 months, and when repeating the procedure, the fat that was harvested and stored during the first fat grafting is thawed and used.

However, if you are satisfied after one procedure, there are many cases where a second procedure is not necessary.

Because fat take rates vary from person to person, the decision about a second procedure should be made after at least 3 months.

Fat take and take rate

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

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

For example, a take rate of 80% means that 80% of the total grafted fat takes, while 20% is absorbed and disappears.

Therefore, the higher the take rate, the better the result.

The area with the lowest take rate is the lips, while the area with the highest take rate is around the eyes.

The average take rate after fat grafting is 50%.

In other words, if 100 units of fat are grafted, only 50% will remain after a few months.

The better the blood circulation, the higher the fat take rate. The area around the eyes has the best blood circulation on the face, so fat grafting there has a higher take rate than in other areas.

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

However, because repeat procedures are sometimes needed, it is better to think of fat grafting as usually being done about twice.

Second procedure and fat harvesting

When fat is harvested from the lower abdomen or thighs, enough fat is collected for grafting, and the fat that is left over is not discarded but stored sterilely in a freezer.

Stored fat can be kept for about 10 months, so if you visit within 10 months, you can receive an additional procedure without harvesting more fat.

Whether the fat is stored or harvested on the spot, the result is the same.

Long-term effect of upper eyelid fat grafting

After fat grafting, fat is gradually absorbed for 3 to as long as 6 months, and the volume decreases.

After that, if the fat fully takes and no further absorption occurs, the remaining fat stays permanently.

The fat that has taken does not melt away or disappear on its own.

If you lose a significant amount of weight later, the grafted area may be affected, but if your weight remains stable, the volume of the grafted area changes very little.

Therefore, the taken fat remains as your own tissue for life.

That does not mean the shape remains the same for life.

As you age, the bones and facial framework change, wrinkles appear in the eyelids, the skin sags, and body weight may decrease, so the appearance of the grafted area will also not stay unchanged.

Until aging progresses significantly, the effect remains consistent.

That is why the term “semi-permanent” is used.

Side effects of upper eyelid fat grafting

Side effects are limited to some swelling and bruising.

Beyond that, there are essentially no other side effects.

Because the procedure uses your own fat rather than a foreign substance, there is no biological rejection reaction or inflammation.

Also, once the fat takes, it is no longer absorbed and becomes your own tissue.

In some cases, people experience side effects after procedures done at clinics with relatively little fat grafting experience, but this is an issue related to the practitioner's technique.

If fat is grafted into the orbicularis muscle layer instead of the orbital fat layer, the eyelids may become heavier and uneven. If too much fat is injected, the eyelids may swell and daily life may become difficult. If excessive fat grafting causes ptosis and makes it hard to open the eyes, or if too much of the fat is absorbed and the effect is not seen, various problems can occur.

Because results differ from clinic to clinic, it is better not to undergo the procedure from a non-specialist plastic surgeon with limited fat grafting experience.

Other treatment methods besides fat grafting

As of now, there is no method other than fat grafting for correcting upper eyelid hollowing.

There are cases where a large lump of fat is grafted through an incision like double eyelid surgery, but this comes with the burden of needing an incision, and grafting a lump of fat can cause the eyelids to feel heavier.

In addition, although various fillers used in plastic surgery (Restylane, Artecoll, Juvederm) are widely commercialized and used, injecting commercial fillers into the upper eyelid can make the eyelid feel firm and make opening the eyes uncomfortable, and inflammation may occur.

Therefore, micro fat grafting using your own tissue is the safe and effective method.

Frequently asked questions about micro fat grafting for the eyelids

Q. Is it true that eyelid fat grafting has many side effects, so it should not be done at other clinics?

A. It is not true that all other clinics are like that.

The upper and lower eye area dark-circle fat grafting procedures are among the areas that require the greatest experience and skill in fat grafting.

They are areas that cannot be treated carelessly without accumulated experience and skill.

We always say in the consultation room that fat grafting is absolutely not a procedure just anyone can do.

As with all surgeries, the results differ depending on the surgeon’s experience and know-how.

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

It is easy to do, but difficult to produce proper results.

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

Methods differ by clinic, and the results can vary greatly depending on experience.

You may have seen or heard about poor fat grafting and developed a negative impression, but if fat grafting is done properly, satisfactory results can be achieved with just one procedure.

In particular, the upper eye area (sunken eyelids, hollow eyelids) requires a great deal of experience, skill, delicacy, and precision, so it cannot be performed by just anyone.

Q. I had eyelid fat grafting at another clinic, but it almost all disappeared and there is hardly anything left. Can it be done again in such a case?

A. Even after treatment at another clinic, repeat treatment is possible if the take rate was low and most of it has disappeared.

However, it must be performed at least 3 months later.

Since the fat grafting take period takes at least 3 months, you can receive another procedure once 3 months have passed since the last one.

Even if the repeat procedure is done at our clinic, the result is almost no different from the first procedure.

Q. I had eyelid fat grafting at another clinic, but it became uneven and it feels uncomfortable to open my eyes. Is this a side effect?

A. The goal of eyelid fat grafting is to restore sunken eyelids and functionally improve the ability to open the eyes, reducing eye fatigue.

To achieve this goal, the procedure must be performed accurately and precisely.

With fat grafting done by someone with limited experience, fat may be placed in the orbicularis muscle layer instead of the orbital fat layer, causing irregularities, or placed near the deep levator palpebrae superioris layer, making it more uncomfortable to open the eyes than before the procedure.

If such a side effect occurs, the fat must be removed again, which is quite difficult.

To prevent side effects, it is better not to receive the procedure from someone with limited experience or from a non-specialist plastic surgeon.

Q. What if filler is injected into the eyelid instead of fat grafting?

A. The eyelid is a structure that moves constantly, so procedures that interfere with eyelid movement should not be done.

When fat is grafted, it acts as a cushion and lubricant that helps the eyelid move more smoothly, but injecting a foreign substance such as filler can seriously impair the function of opening the eyes, regardless of the eyelid's appearance. In severe cases, swelling of the eyelid may not go down, or the shape of the eyes may become distorted.

Inflammation can even occur, so fillers should absolutely not be injected into the eyelid.

Q. After eyelid fat grafting at another clinic, the area became bulging. Can it be corrected?

A. Sometimes people come to our clinic for correction because too much fat was injected at another clinic, causing the eyelid to become heavy and bulge.

Depending on the condition, the fat must be removed by suction. If the fat can be felt as a lump by hand, it can be corrected by inserting a micro cannula and suctioning it out.

However, 100% removal is impossible, and usually about 50–80% can be removed by suction for correction.

Q. Isn't eyelid fat grafting dangerous because it is close to the eyeball?

A. It is not dangerous at all.

The risk is high when it is performed by a doctor with limited experience or by a non-specialist plastic surgeon, but if an experienced specialist performs the procedure accurately, there is no need to worry.

Eyelid fat grafting must be performed by someone who has precise anatomical knowledge and know-how gained through extensive double eyelid surgery experience, and if it is done properly according to principle, it is one of the safe procedures.

Q. My eyelids are sunken. Can fat grafting be done together with double eyelid revision surgery?

A. If the eyelids are hollow and the double eyelid line is also awkward, making revision double eyelid surgery necessary, fat grafting should be done first, and revision double eyelid surgery is possible 3 to 6 months later.

Revision surgery should only be done after the eyes have been restored to a flatter contour following fat grafting.

When performing revision surgery, the tissue must be dissected, and fat grafting cannot be done within the dissected tissue. If fat grafting and revision surgery are done at the same time, it is essentially the same as scattering fat into an empty dissected space, so the fat will not take properly and the double eyelid line will be ruined.

Therefore, doing both surgeries at the same time is not reasonable, and if a clinic recommends doing them simultaneously, you should note that it may be a clinic with limited experience.

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