Duhan Plastic Surgery Under-Eye Surgery - Correction with Fat Grafting After Aegyo-Sal Filler

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Aegyo-sal procedures using filler products (Restylane, Juvederm, Aquamid, Artecoll)

There are many different types of commercially available filler products.

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

However, they are not suitable for large-volume use.

Some products also easily cause inflammation, which can lead to serious side effects.

Because almost all filler products are colorless and transparent, when they are used to create aegyo-sal, the area under the eyes becomes puffy and turns transparent, almost as if a blister has formed. This often looks awkward because it contrasts with the surrounding skin tone.

Because there are concerns about side effects and because of the unnatural appearance caused by the color and texture, this is not a recommended method for creating under-eye contours.

Micro fat grafting for under-eye aegyo-sal

Aegyo-sal is a colloquial term referring to a procedure that gives the area under the eyes a slightly fuller appearance beneath the lower lashes, making the eyes look more defined, attractive, and refined.

The relationship between dark circles and aegyo-sal

When dark circles are distributed directly beneath the eyelashes, fat can be grafted to create aegyo-sal in this area. During this process, the dark skin is stretched and the yellow fat is added, which helps soften the appearance of dark circles.

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

However, if aegyo-sal is created in eyes with a sunken under-eye area, shadows become more pronounced beneath the aegyo-sal, making the under-eye area look darker. Therefore, only suitable candidates should undergo the procedure after an accurate examination.

An ideal method of micro fat grafting for under-eye aegyo-sal

Under-eye micro fat grafting should basically be performed as a three-dimensional fat grafting procedure.

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

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

For this, subcutaneous tunneling is an essential step, and bruising occurs during this process.

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

If grafting is done directly without tunneling in order to minimize bruising, bruising may be reduced, but in most cases the shape becomes awkward or uneven. Therefore, a thorough preparatory process through subcutaneous tunneling before grafting is necessary for good results.

How micro fat grafting for under-eye aegyo-sal is performed for attractive eyes

"The procedure process for primary fat grafting"

Fat grafting is performed in a step-by-step, systematic process.

The procedure involves several stages, including painless sedation anesthesia, fat harvesting, purification, tunneling, and grafting.

① Fat is harvested from areas where your own fat is stored in large amounts, 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 fat into a syringe.

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

③ The oil is removed through a second-stage purification process.

④ The purified fat is placed into a 1 cc syringe. Usually, about half to one syringe is grafted under one eye.

⑤ A micro fat grafting cannula is inserted along the planned under-eye design line to perform the grafting.

The graft is placed within or above the orbicularis oculi muscle layer, creating a soft contour and a high survival rate.

⑥ After the procedure, normal daily life is possible right away, and face washing and makeup are allowed starting the next day.

The procedure process for secondary fat grafting

The procedure process for secondary fat grafting

Fat grafting does not always end with one session.

Survival rates differ by area, and there are individual differences as well.

Because an average of about 50% of grafted fat is absorbed, the initial result may look good, but as time passes it is gradually absorbed, so a second procedure may be needed if necessary.

○ Three to ten months after the first fat grafting, you return to the plastic surgery clinic for follow-up.

○ If a second fat grafting is judged necessary, the frozen fat stored during the first procedure is thawed and injected again under local anesthesia.

○ Since the fat harvesting step is omitted compared to the first procedure, the procedure time is much shorter, and the cost is about half of the first fat grafting procedure.

○ If the fat survives well after the first procedure and the shape is judged to be satisfactory, no further fat grafting is needed.

In other words, a second procedure is performed only when necessary, and whether to proceed is based on your own assessment of the result.

Fat grafting usually involves one to two procedures.

If a second procedure is needed, it is typically performed within three to ten months.

Examples of under-eye aegyo-sal micro fat grafting procedures

Post-procedure care after under-eye aegyo-sal micro fat grafting

The under-eye aegyo-sal area bruises easily.

Careful management of bruising is necessary.

① Starting the day after the procedure, cover the bruised areas well with skin-colored makeup.

② Normal daily life is possible starting the day after the procedure, and if swelling does not go down well around one week later, an injection to reduce swelling may be helpful.

③ Four days after the procedure, it is fine to sweat in a sauna or jjimjilbang.

Other ways to create under-eye aegyo-sal

Method using fat repositioning

Some clinics may suggest creating aegyo-sal through fat repositioning.

It is not possible to create satisfactory aegyo-sal through fat repositioning.

Aegyo-sal should protrude smoothly just beneath the eyelashes, but orbital fat cannot be forcibly pushed toward the lash line to create a natural aegyo-sal contour.

In most cases, the aegyo-sal shape is barely created, or the protrusion appears below the eyelashes rather than directly beneath them, resulting in an awkward shape.

Creating aegyo-sal with fat repositioning should be approached with caution.

Method using AlloDerm (acellular dermal matrix)

Some cases use solid artificial dermis such as AlloDerm or SureDerm to create aegyo-sal, but this requires making an incision in the skin, carries the burden of scar formation, does not produce a natural shape, and can create an artificial look, so it is not a recommended method.

In the case of liquid AlloDerm, the cost is high and the absorption rate is high, so when sufficient protrusion is desired, the result is often inadequate.

Common questions and answers about under-eye aegyo-sal procedures

Question) If aegyo-sal was created with filler, is it possible to correct it later with fat grafting?

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

However, once someone has undergone filler treatment, under-eye aegyo-sal fat grafting cannot be performed.

The reason is that the area treated with filler is not a suitable environment for fat to survive.

Because blood circulation is poor, the fat may not survive and side effects such as inflammation or fat necrosis may occur. Even if some fat survives, the survival rate may be low or the shape may not look natural.

Some people ask whether it is possible to dissolve all the filler with dissolving injections and then perform fat grafting. If the filler is hyaluronic acid-based (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 dissolving injection, fat grafting is not possible if part of the aegyo-sal shape remains.

Even if the filler is dissolved with a dissolving injection, some residue remains, so there is still a risk of 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 under-eye aegyo-sal fat grafting possible?

Answer) Lower blepharoplasty is a method that removes and tightens skin to smooth wrinkles caused by under-eye wrinkles or sagging.

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

In this condition, creating aegyo-sal is difficult.

For aegyo-sal to form naturally, there must be enough skin to expand, but because lower blepharoplasty removes skin, there is almost no room for the skin to expand.

Also, scar tissue at the incision site prevents the shape from being formed properly.

Therefore, after lower blepharoplasty, it is difficult to create aegyo-sal.

As an exception, if the scar line is faint and a long time has passed since the lower blepharoplasty, leaving even a small amount of extra skin, a small amount of aegyo-sal may be possible.

Question) If aegyo-sal was created with AlloDerm, is it possible to correct it later with fat grafting?

Answer) People who have had procedures with AlloDerm (acellular dermal matrix) often want fat grafting again because they are dissatisfied with the shape.

Because AlloDerm is a living tissue, if the AlloDerm shape is not protruding in a very awkward way, the shape can be created with fat grafting.

However, if the shape is awkward, the protrusion is severe, or the protrusion is not directly beneath the eyelashes but lower down, correction with fat grafting is difficult.

Conversely, fat grafting is possible only when the AlloDerm has been placed in the correct position directly beneath the eyelashes and the shape is mild.

Question) At another clinic, they say that creating aegyo-sal with fat grafting does not look pretty and causes unevenness. Is that true?

Answer) There are clinics that perform contouring with fillers indiscriminately.

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

Filler-like materials that are not fat grafting products (Aquamid, Restylane, Artecoll, etc.) were not made for contouring procedures.

Therefore, they come with limitations in treatment and have several problems, including side effects and reduced effectiveness.

The problem is that non-specialist plastic surgery doctors and some inexperienced doctors overuse fillers in procedures.

Features of Duhan Plastic Surgery Clinic's fat grafting clinic

All anesthesia is performed as local anesthesia (sedation anesthesia).

Local anesthesia is performed together with sedation anesthesia, and the procedure is carried out without any pain during anesthesia or after the anesthesia is completed.�b

It has a systematic and advanced fat grafting system.

Living fat cells are harvested, and their purity is maximized through centrifugation, purification, and removal of unnecessary oil.

Before grafting, subcutaneous tunneling is performed in the graft area to secure space for the graft.

Precise grafting is performed using a micro fat grafting cannula.

By grafting in multiple layers in a three-dimensional manner, a soft contour is created while maximizing the survival rate.

Suitable and diverse fat harvest sites are selected.

The most commonly used area is the lower abdomen. It is often chosen first because it causes less pain after the procedure and has less swelling and bruising, making daily life easier.

The next preferred area after the lower abdomen is the inner thigh, followed by the outer thigh.

If there is not enough fat in the thighs, the lower buttocks or sides of the waist may also be used.

There is no fixed rule for which area provides the best fat survival rate.

The results are similar, and the area with the most excess fat is ideal, but it is best to decide the harvest site by considering the amount of fat needed and your activity after the procedure.

The second-stage purification process of harvested fat maximizes the survival rate.

Among the impurities in harvested fat, local anesthetic solution accounts for the largest portion, followed by oil.

Other impurities include serum and red blood cells.

In the first stage, the fat undergoes centrifugation for about 3 to 4 minutes before entering the second-stage oil-removal process.

The oil is removed manually through natural absorption.

Through the second-stage purification process, highly concentrated fat of nearly 100% is obtained, maximizing the effect of fat grafting while also increasing the survival rate as much as possible.

Subcutaneous tunneling is used to secure space for fat grafting.

Subcutaneous tunneling refers to securing space in advance in the area where fat will be grafted. It is an essential and important step for high fat survival and even grafting.

Using a thin probe, the skin under the skin is moved repeatedly in a fan-like pattern to create space for the grafted fat.

The effect of subcutaneous tunneling is to increase fat survival and prevent fat from clumping, allowing for a uniform and smooth contour.

Three-dimensional micro fat grafting can achieve a soft and even facial contour.

Although there are exceptions depending on the area, the basic method of fat grafting is a three-dimensional approach.

Fat is divided into multiple layers and grafted in small amounts evenly across each area.

Micro fat grafting cannulas are used for precise fat grafting.

In the past, methods using fat injection machines forced fat under the skin at high pressure, which caused various problems.

The absorption rate of fat was high and the survival was not consistent, leading to uneven contours, and it was difficult to graft in delicate areas such as under the eyes.

To solve these problems, during fat grafting the fat is transferred again into a thin 1 cc syringe and grafted into the desired area.

At Duhan Plastic Surgery's micro fat grafting clinic, we use our own developed microneedles (micro grafting cannulas).

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

Fat grafting can also be performed on the upper eyelids, lower eyelids, forehead wrinkles, glabellar wrinkles, nasolabial folds, and the bridge of the nose, making fat grafting possible in almost all cases except fine wrinkles.

Molding immediately after fat grafting helps create a uniform and smooth facial contour.

Immediately after fat grafting, delicate molding is performed so that the grafted fat spreads evenly and forms a smooth shape.

Molding is the final stage of fat grafting and one of the most important steps.

Cryopreservation and sterile storage of leftover fat simplify secondary procedures.

If a second procedure is performed three months after fat grafting, the leftover fat from the first procedure is used without harvesting fat again.

The leftover fat after the first procedure is rapidly frozen and stored under sterile conditions.

For the second procedure, the stored fat is thawed, making the procedure more convenient.

The storage period for fat is up to 10 months, and if you visit within 10 months, the procedure will be performed using the stored fat.

Because fat grafting uses your own fat, there are almost no side effects, unlike commercial filler materials.

Aside from slight swelling and bruising after the procedure, there can be considered to be no side effects at all.

Therefore, it can be said to be safer than any other plastic surgery procedure.

However, this refers to cases where fat grafting is performed properly. If a procedure is performed against the principles, side effects may occasionally occur, such as uneven contours, fat necrosis and hardening, inflammation, or awkward shapes caused by excessive injection.

These issues depend on the practitioner's experience and skill; they are by no means a general problem with fat grafting itself.

Therefore, if the procedure follows the correct principles, these side effects are rare.

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