[Duhan Plastic Surgery Fat Grafting] - [Dark Circles, Under-Eye Wrinkles]

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Dark Circles - Under-eye Wrinkles

Become more beautiful with smooth and attractive facial contours through micro fat grafting ~

Trademark registration for Colpet Fat Grafting - Colpet Fat Grafting is the intellectual property of Duhan Plastic Surgery alone.

Dark circle treatment guide

Dark circles under the eyes

is a general term for a condition where the under-eye area looks dark.

Under-eye fat grafting can naturally fill in wrinkle lines or dark areas caused by hollowness or depression, helping to restore a brighter eye area.

The sunken wrinkle lines under the eyes

refer to indented wrinkles caused by shadows under the eyes.

They are different from fine wrinkles, and the shadows create light-and-dark contrast, making the under-eye area look darker.

In such cases, fat grafting can fill in the shadowed wrinkle lines and help restore a youthful eye area.

Different types of dark circles and sunken wrinkle lines under the eyes

Causes of dark circles

◎ Under-eye hollowness (depression) - When the under-eye area sinks in, shadows form and it inevitably looks dark.

◎ Color of the orbicularis oculi muscle under the eyes - The muscle can have a reddish color, so the orbicularis oculi muscle can appear red.

◎ High skin density - The denser the skin, the darker it can look, and fine wrinkles are also more numerous.

◎ Deposition of melanin pigment in the skin - Melasma, freckles, age spots, and more

The effect of correcting dark circles with micro fat grafting

| 1. As fat grafting corrects the under-eye hollowness, the dark shadow effect is reduced.2. By expanding the skin, it can reduce fine wrinkles and the density of melanin pigment in the skin.3. By placing yellow fat under the skin, the dark reddish tone can be diluted and lightened. |

| Under the skin beneath the eyes sits the red orbicularis oculi muscle layer, so the main cause of most dark reddish dark circles is the projection of the color of this muscle layer through the skin. The principle of the procedure is to precisely graft yellow fat into the muscle layer or just above it so that the red color of the muscle does not project outward, and instead skin-colored tone is projected from the outside. For this procedure to be possible, the under-eye area must be somewhat sunken. |

Cases where fat grafting can be effective

Under-eye micro fat grafting is suitable when the under-eye area is somewhat sunken.

If the under-eye area is not sunken and is instead protruding, the under-eye orbital fat should first be removed before fat grafting. If fat grafting is performed on a protruding or flat under-eye area, the under-eye area may appear even more protruded, which can have the opposite effect.

Cases where fat grafting cannot be effective

Dark circles with a protruding under-eye shape
Cases with excessive under-eye wrinkles
Dark circles with severely sagging skin
Cases with excessive melanin pigmentation

How fat grafting is performed for attractive eyes

| 1. Fat is harvested from areas where body fat is abundant, such as the lower abdomen, waist, or thighs.- Because local anesthesia (painless sedation anesthesia) is used, there is no pain at all.- A thin liposuction cannula is used to collect the fat into a syringe.2. The harvested fat is centrifuged to remove impurities (anesthetic, oil, blood, serum, water, etc.).3. The oil is removed through a two-step purification process. Only after almost all of the oil is removed can it truly be called concentrated fat.4. The purified fat is placed into a thin 1cc syringe. Although it varies by person, usually about half to one 1cc syringe is grafted under each eye.5. A micro fat grafting cannula is inserted along the planned under-eye design line to perform the grafting. The graft is placed inside and above the orbicularis oculi muscle layer, creating a smooth contour and a high engraftment rate.6. After the procedure, daily life is possible right away, and face washing and makeup are allowed starting the next day. |

| Fat is harvested from areas where body fat is abundant, such as the lower abdomen, waist, or thighs. Since the under-eye area does not require a large amount of fat, fat is usually harvested from the lower abdomen in most cases. Fat is collected gently with a syringe and a thin suction cannula to obtain living fat cells. If a large cannula is used, the fat is suctioned too roughly, making precise grafting difficult, so using a thin cannula is preferable. During suction, fat is collected and dispersed over a wide area so that no contour irregularity occurs in the abdomen. |

| The harvested fat is placed in a centrifuge to remove impurities. The impurities include blood, serum, anesthetic, oil, and water, while the components purified by centrifugation are mainly blood, anesthetic, and water. Oil and other components are removed in a second step by a natural adsorption method. |

| Fat from which even the oil component has been almost completely removed is called concentrated fat. The concentrated fat is transferred into a 1cc syringe and fitted with a micro grafting cannula. We use the micro needle (micro grafting cannula) developed in-house. The micro needle is a special cannula used only at our clinic, enabling ultra-precise grafting. The procedure is injected into the under-eye area under local anesthesia, and the injection is carefully and evenly distributed across the designed area. It is important to distribute the appropriate amount of fat evenly without clumping in order to ensure fat engraftment and a smooth contour. |

Understanding micro fat grafting under the eyes

Understanding the under-eye anatomy of dark circles and fat grafting

In the above photo, there are two causes of dark circles.

One is a dark circle caused by under-eye hollowness, which creates shadows, and the other is a dark circle caused by pigmentation of the skin melanin.

For correction, micro fat grafting is performed on the sunken area to improve the shadow effect, and yellow fat is grafted between the orbicularis oculi muscle layer and the skin to dilute the melanin pigment and restore the dark tone closer to the skin tone.

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

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

Understanding the anatomy of under-eye sunken wrinkles and fat grafting

The under-eye sunken wrinkles in the photo above are fold-like wrinkle lines with no skin sagging at all.

To correct this, fat is grafted into the layer beneath the wrinkle line skin so that the wrinkle is pushed up to the level of the surrounding skin tissue, smoothing the wrinkle.

After fat grafting, the dark shadow effect caused by the wrinkle line disappears and dark circles improve.

Under-eye fat grafting must be performed delicately without making any incision in the skin, using a micro fat grafting cannula.

In practice, the success of the procedure depends on accurately determining the proper amount and evenly injecting it.

Examples of under-eye fat grafting

Ideal method for under-eye fat grafting

Under-eye micro fat grafting should basically be three-dimensional fat grafting.

To prevent an uneven contour after fat grafting, the appropriate amount should be spread and grafted evenly.

Usually, the graft is divided and placed below the orbicularis oculi muscle layer, within the orbicularis oculi muscle layer, and above the orbicularis oculi muscle layer.

For this purpose, subcutaneous tunneling is an essential part of the process, and bruising occurs at this time.

Because the area around the eyes has many blood vessels, some bruising is unavoidable.

If tunneling is not done to minimize bruising and the graft is inserted directly, bruising may be reduced, but in most cases the shape becomes awkward or irregular, so thorough pre-procedure preparation through subcutaneous tunneling is necessary to achieve good results.

The principle of correcting dark circles with fat grafting

The causes of dark circles vary. In some cases, melanin pigment is deposited in the skin, and in others, the skin folds in too tightly, creating many fine wrinkles that make the area look dark.

Micro fat grafting cannot change skin color directly, but in the case of dark circles caused by skin contracted like a rubber band, it can expand the skin and make the skin tone appear lighter. In cases where the skin is pigmented, grafting fat under the skin allows the yellow fat to color-correct the dark reddish skin tone, making the skin appear lighter.

In addition, when the under-eye area is sunken, shadows form, and fat grafting can also reduce that shadowing effect.

Number of under-eye fat grafting procedures

How many times fat grafting should be done depends on the engraftment rate of the fat.

Because this varies by person, the decision is made after checking the result of fat engraftment after about 3 months.

If needed, a second fat grafting procedure is performed between an average of 3 and 10 months.

In the under-eye area, the fat engraftment rate is higher than in other areas, so satisfactory results are often achieved with just one procedure.

Therefore, a second procedure is performed only when necessary, and it is rare to go beyond a third procedure.

What are engraftment and engraftment rate in under-eye fat grafting?

There are differences in the engraftment rate of fat cells depending on the facial area.

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

For example, an 80% engraftment rate means that 80% of the total grafted fat remains engrafted and 20% is absorbed.

Therefore, the higher the engraftment rate, the greater the correction effect.

The area with the lowest engraftment rate is the lips, and the areas with the highest engraftment rate are the cheeks and around the eyes.

The average engraftment rate after fat grafting is 50%.

In other words, after grafting 100 units of fat, only 50% remains after a few months.

The better the blood circulation in an area, the higher the engraftment rate of fat. Since the area around the eyes has the best blood circulation on the face, the engraftment rate is relatively higher than in other areas when fat grafting is performed.

Therefore, the area around the eyes often achieves a permanent effect with just one procedure.

However, since repeat procedures are sometimes done, having the procedure done with the expectation of about two sessions can lead to satisfactory results.

Whether fat needs to be harvested for a second fat grafting procedure

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

This stored fat can be kept for about 10 months, so if you visit within 10 months, you can receive a repeat procedure in the desired area.

However, if you come in after 10 months for a second procedure, the fat must be harvested again for treatment.

When to resume activity after fat grafting

Exercise such as walking, stretching, or weight training is possible immediately after the procedure, but running should be avoided for about a month to improve fat engraftment.

However, bruising in the treated area can interfere with social activities, so the possibility of bruising should be considered before the procedure.

The upper eyelid area does not usually bruise much, but the under-eye area is a region where some bruising must be accepted.

Swelling and bruising vary by person but usually disappear after 1 to 2 weeks, and during that time they can be covered with makeup or concealer.

However, it does not significantly interfere with daily life.

Side effects of under-eye fat grafting

The side effects are limited to mild swelling and bruising.

Other side effects can be said to be essentially nonexistent.

Sometimes people worry that the under-eye contour may not be smooth and may become uneven, but this is related to the operator’s experience and skill.

Therefore, under-eye fat grafting requires extensive experience and know-how, and it is not a procedure just anyone can perform.

Under-eye procedures only produce good results when precise technique is used and the appropriate amount of fat is evenly injected.

Ultimately, the success of the procedure depends on how well the operator performs it.

To achieve this, subcutaneous tunneling is performed, and a micro fat grafting cannula is used so that no incision is made in the under-eye area, and the appropriate amount is precisely grafted into the sunken area to achieve good results without side effects.

Also, if an awkward shape occasionally appears, the operator must have the ability to correct it simply and immediately.

Other methods besides fat grafting

1. Under-eye fat repositioning

Under-eye fat repositioning is not a procedure for correcting dark circles.

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

If this procedure is performed when the under-eye area is not bulging, it can easily cause side effects such as the under-eye area becoming sunken or forming step-like layers.

Therefore, it is a surgical method in which it is very difficult to obtain the desired result properly.

Also, because the surgery is performed through the conjunctiva, the field of view is not secured, so the surgery often cannot be performed properly, and there are not many people who are an exact fit for whom fat repositioning can produce good results.

2. Method using fillers

Fillers such as Restylane, Artecoll, or Aquamid should not be used indiscriminately under the eyes.

The purpose of fillers is not to create contouring.

They are simply intended for correcting fine wrinkles and small depressed scars.

They are often injected into the aegyo-sal area under the eyes or into sunken areas under the eyes, which can make the eyes look awkward or cause side effects.

Also, because fillers are transparent in color, injecting them under the eyes often makes the area look pale and awkward.

They can also create uneven contours, or spread and cause protrusions in unintended areas.

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

Many people complain that filler procedures under the eyes leave the shape awkward or cause side effects.

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

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

3. Vascular laser treatment

Dark circles can hardly be improved with laser treatment.

For reddish dark circles, laser treatment is sometimes used to reduce the redness. Laser can burn small capillaries within the skin layer and treat redness, but it cannot change the redness under the eyes.

The reason is that the cause of the redness is not the 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 remains 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, and although freckles and age spots can be removed, it is difficult to solve the overall dark appearance under the eyes.

4. When 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 whenever possible.

Some hospitals recommend fat removal and fat grafting together, and then perform fat grafting immediately after fat removal.

In such cases, it is difficult to obtain satisfactory results.

At our clinic, there are cases where fat removal is followed by fat grafting, but fat removal is done only when truly necessary, and it is not performed at the same time as fat grafting.

Usually, there is an interval of one month between procedures.

The reason is that once the result of fat removal is visible, we can design accurately to match it and adjust the amount of grafted fat according to the degree of hollowness, allowing for precise treatment.

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

In under-eye procedures that require very high precision, such actions go against the proper principles of treatment.

In some cases, the eye area does not need fat removal at all, yet fat removal is suggested along with grafting even for a sunken eye area.

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

If fat removal is performed without considering whether there is too much or too little fat under the eyes, it is a procedure beyond common sense.

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

If there is bulging, fat removal is appropriate, but if a provider recommends fat removal for an eye area with almost no bulging and also recommends fat grafting at the same time, this should clearly be reconsidered.

Many people come to our clinic for correction after being dissatisfied with simultaneous fat removal and fat grafting performed at other hospitals.

Such illogical procedures should not be done in the delicate under-eye area.

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

In the photo above, there is protrusion of the orbital fat under the eyes and a sunken wrinkle line beneath it, so our clinic planned fat removal and fat grafting.

② The protruding area has improved, but the sunken wrinkle line remains, so fat grafting is planned after one month

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

However, the sunken wrinkle line below the fat removal area was not corrected.

Fat removal is a surgery to correct under-eye protrusion, and it does not always resolve the sunken wrinkle line beneath the eyes.

③ Appearance after fat grafting one month after fat removal

One month after fat removal, the sunken wrinkle line remained, so the area was precisely designed accordingly and the amount of fat to be grafted was adjusted before grafting.

After the additional fat grafting following fat removal, the shadow line under the eyes disappeared and the dark circles improved.

After the result of the previous procedure appears, it should be checked and then planned accurately before grafting.

If a clinic recommends fat removal and grafting at the same time, it should be reconsidered.

Also, if a clinic recommends fat removal and grafting at the same time for an eye area that does not need fat removal at all, it should also be reconsidered.

Dark circle surgery can be performed

at any hospital,

but there are not many hospitals that accurately analyze the patient type

and choose the appropriate surgical method accordingly.

Dark circle surgery may seem easy, but it is by no means an easy operation.

We have experience with various types of surgeries and the answers to them.

Director Shin Duhan

Micro fat grafting for under-eye aegyo-sal treatment

This is a procedure performed when the under-eye area is sunken or has a sunken wrinkle line, causing dark circles and making the eyes look less attractive. Fat is harvested from the lower abdomen or thighs using a thin suction cannula and then grafted back under the eyes with a micro fat grafting cannula to correct under-eye hollowness or wrinkle lines and brighten the skin tone.

The relationship between dark circles and aegyo-sal

If dark circles are distributed just below the eyelashes, fat can be grafted to create a subtle bulge in that area and make aegyo-sal. In this process, the dark skin expands and yellow fat fills in, which helps reduce the dark circles.

It also creates aegyo-sal, changing the eyes into a more attractive look.

However, if aegyo-sal is created in an eye area that is already sunken under the eyes, shadows under the aegyo-sal become more pronounced and the under-eye area becomes darker, so aegyo-sal should only be performed on people who are a proper match based on an accurate examination.

Examples of micro fat grafting for aegyo-sal

Care after aegyo-sal treatment

Aegyo-sal is an area where bruising tends to occur easily during under-eye fat grafting, so careful bruise management is needed.

□ From the day after the procedure, cover the bruised area well with skin-toned makeup.

□ Daily life is possible from the day after the procedure, and if swelling does not go down well around one week later, a swelling-reducing injection may help.

□ Four days after the procedure, it is fine to sweat in a sauna or jjimjilbang.

Other ways to create aegyo-sal

1. Filler products (Restylane, Juvederm, Aquamid, Artecoll)

There are many types of commercially available filler products.

They are usually developed to improve fine wrinkles, so if used for that purpose, there is no major problem.

However, they are not suitable for use in large amounts.

Also, some products can easily cause inflammation, which may lead to serious side effects.

Because almost all filler products are colorless and transparent, when used to create aegyo-sal the under-eye area can become bulging and look as if a blister has formed, appearing transparent and often awkward compared with the surrounding skin tone.

They are not recommended for creating under-eye contour because of concerns about side effects and unnatural appearance due to the color and texture.

2. Method using fat repositioning

Some hospitals suggest creating aegyo-sal with fat repositioning.

It is impossible to create satisfactory aegyo-sal with fat repositioning.

Aegyo-sal should protrude with a soft contour just below the eyelashes, but pushing orbital fat toward the lash line cannot create a natural aegyo-sal contour.

In most cases, the shape of aegyo-sal is barely created, or the protrusion appears not just below the eyelashes but below that, resulting in an awkward shape.

Be cautious about creating aegyo-sal with fat repositioning.

3. Method using Alloderm (acellular dermal matrix)

Aegyo-sal can also be created using solid artificial dermis such as Alloderm or SureDerm, but this requires skin incision, creates scars, and does not produce a natural shape, leaving an artificial impression, so it is not a recommended method.

In the case of liquid Alloderm, the cost is high and the absorption rate is high, so the results are often insufficient when a sufficient protrusion is desired.

Common frequently asked questions and answers about aegyo-sal treatment

Question) If aegyo-sal was treated with fillers, can it be corrected again with fat grafting?

Answer) Many people who received filler treatment later want fat grafting again because of various problems.

However, once a person has had filler treatment, aegyo-sal fat grafting cannot be performed.

The reason is that the filler-treated area is not a condition in which fat can engraft.

Because blood circulation is poor, the fat cannot engraft and side effects such as inflammation or fat necrosis may occur. Even if some engraftment occurs, the engraftment rate may be low or the shape may not be natural.

Some people ask whether the filler can be completely dissolved first with a dissolution injection and then fat grafting performed. If the filler was a hyaluronic acid product such as Restylane or Juvederm, it can be dissolved with an enzyme injection called hyaluronidase.

However, unless the filler is almost completely dissolved with the dissolution injection, if part of it remains and the aegyo-sal shape is still present, fat grafting is not possible.

Even if the filler is dissolved with a dissolution injection, some residue remains, so there is still concern about inflammation after fat grafting. In principle, anyone who has ever used filler cannot undergo fat grafting.

Question) I had lower blepharoplasty because of under-eye wrinkles. Is aegyo-sal fat grafting possible?

Answer) Lower blepharoplasty is a method of removing skin and pulling it tight to smooth wrinkles caused by wrinkles or sagging under the eyes.

After lower blepharoplasty, the skin is pulled tight, so there is no extra skin, and scar tissue forms just below the eyelashes.

In this state, creating aegyo-sal is difficult.

For aegyo-sal to form naturally, there must be some extra skin so it can expand, but lower blepharoplasty removes skin, leaving almost no room for the skin to expand.

Also, scar tissue at the incision line makes it difficult to create the proper shape.

Therefore, after lower blepharoplasty, creating aegyo-sal is difficult.

Exceptionally, if the scar line is faint and a long time has passed since lower blepharoplasty so that there is a little extra skin, small aegyo-sal can be attempted.

Question) If aegyo-sal was treated with Alloderm, can it be corrected again with fat grafting?

Answer) Many people who were treated with Alloderm (acellular dermal matrix) later want fat grafting again because they are dissatisfied with the shape.

Because Alloderm is living tissue, if the Alloderm shape is not extremely awkward and simply protrudes, fat grafting can be used to shape it.

However, if the shape is awkward or the protrusion is severe, or if it is not protruding directly below the eyelashes but instead below that area, correction with fat grafting is difficult.

Conversely, fat grafting is possible only when Alloderm has been inserted into the proper position just below the eyelashes and the shape is mild.

Question) At other hospitals, they say aegyo-sal made with fat grafting does not look pretty and becomes uneven. Is that true?

Answer) Some clinics perform contouring indiscriminately with fillers.

We also use fillers, but fillers are only used for fine wrinkles or small depressed scars.

Fillers such as Aquamid, Restylane, and Artecoll are not products made for contouring.

Therefore, their use carries limitations, side effects, and several problems with reduced effectiveness.

The problem lies in non-specialist cosmetic surgeons and some inexperienced doctors who overuse fillers.

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In addition to fat grafting, filler or Alloderm may be used in some cases.

Because fillers such as Restylane are transparent, after the procedure the under-eye area can lose all natural color,

become pale like a blister, look awkward, and, since it is a foreign material, may change shape and possibly flow downward.

Alloderm grafting through incision is an excessive procedure that leaves scars,

and the shape also does not come out naturally.

For this reason, many people visit our clinic and receive repeat treatment with filler dissolution and fat grafting.

Therefore, from experience, fat grafting seems to be the best method.

The advantages of fat grafting are

that because it is autologous tissue, there are no side effects,

it looks natural,

and daily life is possible immediately.

Aegyo-sal is

performed selectively only when it suits the patient’s own eye shape,

so you do not need to worry about whether it will suit you.

Based on extensive clinical experience and know-how,

rather than injecting a large amount into one place through tunneling,

we perform three-dimensional micro fat grafting with 100% concentrated fat distributed evenly across multiple layers.

In addition, a delicate injection method allows for customized design.

To minimize swelling and bruising during the procedure,

we mix an anti-swelling agent with the anesthetic and administer it,

and provide painless sedation under local anesthesia.

Director Shin Duhan

http://www.duhans.com