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Causes of treatment failure for dark circles under the eyes

1. When treating dark circles with laser

There are many types of medical lasers.

Lasers that can be used to treat dark circles include carbon dioxide ablative lasers, erbium:YAG ablative lasers, excimer lasers, Nd:YAG lasers, and alexandrite lasers.

Effectiveness of ablative lasers

Ablation means lightly shaving off the skin. Using a laser to perform ablation can shave off the superficial layer of the epidermis or dermis and remove thinly distributed blemishes or age spots.

They are effective for localized blemishes or age spots, but in most cases they are hardly effective at all for treating overall dark circles under the eyes.

Effectiveness of pigment lasers

Pigment lasers are mainly lasers that destroy red capillaries. They can be used for telangiectasia within the skin layer, but they are almost ineffective for the red muscle layer beneath the skin or the vascular network that forms the muscle layer.

Therefore, dark circles cannot be treated with pigment lasers; they only partially remove red capillaries within the skin layer.

However, removing a few capillaries in the skin layer does not make dark circles disappear.

The fundamental cause is the red muscle layer projected through the thin skin, so the color of this muscle layer must be changed. But no matter how much laser is applied, the red muscle layer will not turn skin-colored.

This is practically impossible.

Therefore, if the dark circles are dark reddish due to thin skin, they are almost impossible to treat with laser.

2. When correcting dark circles with filler

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

Fillers are not made for contouring procedures.

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

Injecting them into under-eye aegyosal or depressed areas under the eyes can make the eyes look awkward or cause side effects.

Many people suffer from filler side effects, so caution is needed.

Also, because fillers are transparent in color, when injected under the eyes the color often becomes pale and looks awkward.

They can also create a bumpy shape, or spread so that the wrong area becomes protruded.

Fillers are not for under-eye procedures; they are for correcting fine wrinkles around the eyes.

Many people complain that filler treatment under the eyes makes the shape look awkward or causes side effects, and fillers should absolutely not be injected under the eyes.

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

Fillers should only be used for fine wrinkles around the eyes, fine forehead wrinkles, fine wrinkles around the mouth, or small depressed scars.

If an incorrect shape or side effect occurs from filler treatment, correction is almost impossible.

We often receive inquiries from patients who had incorrect filler procedures at other clinics and want correction here, but there is no special way to correct it, so getting filler under the eyes is not recommended.

3. Under-eye fat repositioning with the wrong indication

Under-eye fat repositioning is not surgery that brightens the color under the eyes.

Under-eye fat repositioning is a contour correction procedure that removes orbital fat and moves it to the area below the protrusion in order to correct both the protruding and sunken areas at the same time.

However, in many cases, people whose eyes do not have much fat to reposition are still recommended this procedure.

In such cases, after fat repositioning, the under-eye area often becomes hollow or does not improve at all.

The problem with fat repositioning is that it hardly brightens the under-eye color, and it is also difficult to create the flat contour people want.

Because the surgery is performed through the conjunctiva, the field of view is not secure and the operation is not performed properly. You should keep in mind that there are not many people for whom fat repositioning is truly suitable and can produce good results.

Four unsatisfactory points of under-eye fat repositioning

① When the amount of fat is insufficient, after fat repositioning the protruding area where the fat used to be may instead become hollow

② When there is a large amount of fat, after fat repositioning the original protruding area may still appear protruded

③ After fat repositioning, the original depressed area may, conversely, appear protruded

④ When the amount of fat is small, even after fat repositioning the original depressed area may not be filled properly and may still appear shadowed and sunken

Under-eye fat repositioning should not be applied carelessly to people who do not have much orbital fat, because in actual results it often leads to dissatisfaction or an awkward appearance.

Also, you should not expect much improvement in under-eye color from fat repositioning, and it is only suitable for contour correction purposes.

However, cases where the desired flat under-eye area is achieved are extremely rare.

At other clinics, there are many cases where fat repositioning is recommended for eyes with almost no protruding under-eye fat, and this is something to consider carefully.

After under-eye fat repositioning, rather than becoming flatter, the under-eye area may become hollow or protruded, leading patients to seek correction here. If it is sunken, it can be corrected again with micro fat grafting.

4. When under-eye fat removal and under-eye fat grafting are performed at the same time

It is best not to perform fat removal and fat grafting at the same time.

At other clinics, patients are sometimes advised to undergo fat removal and fat grafting simultaneously, or to have fat grafting immediately after fat removal.

In such cases, satisfactory results are difficult to achieve.

At our clinic, there are cases where fat grafting is done in combination after fat removal, but fat removal is performed only when absolutely necessary, and it is not done at the same time as fat grafting.

Usually, the procedures are done about one month apart.

The reason is that once the result of fat removal is visible, the design can be planned accurately based on that result, and the graft amount can be adjusted according to the degree of depression for a more precise procedure.

But if fat grafting is done immediately after fat removal, before knowing which area will sink and by how much, proper fat grafting is not possible.

It is the same as applying color roughly without knowing what the sketch will look like.

In an under-eye procedure that requires great precision, this kind of action goes against the principles of the procedure.

In some cases, there are eyes that do not need fat removal at all, or even cases where people are advised to remove fat and graft at the same time despite having sunken eyes.

Fat removal should only be performed when there is severe protrusion under the eyes.

If fat is removed unconditionally without considering whether there is much or little fat under the eyes, that is beyond common sense.

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

If there is protrusion, fat removal is needed, but if someone with almost no protrusion is advised to have fat removal and simultaneous fat grafting, it should definitely be reconsidered.

There are many cases where people come here for correction after being dissatisfied with simultaneous fat removal and fat grafting at another clinic.

Such unreasonable procedures should not happen in under-eye treatment, which requires precision.

① A case where the orbital fat under the eyes is protruding and there is a depressed wrinkle line beneath it

The photo shows protruding orbital fat under the eyes and a depressed wrinkle line beneath it, so we planned fat removal and fat grafting here.

② The protruding area improved, but the depressed wrinkle line remained, so fat grafting was planned one month later

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

However, the depressed wrinkle line beneath the fat removal area was not corrected.

Fat removal is a surgery that corrects protrusion under the eyes, and in some cases it does not solve the depressed wrinkle line under the eyes.

③ Appearance after fat grafting performed one month after fat removal

One month after fat removal, the depressed wrinkle line remained, so we designed the treatment precisely to match it and performed the graft with the amount of fat adjusted accordingly.

★ After the procedure, the shadow line under the eyes disappeared and the dark circles improved.

In this way, after the results of the previous procedure are visible, you should check those results and make a precise plan before grafting.

If you are advised to have fat removal and grafting at the same time, you should reconsider.

Also, if someone is advised to undergo simultaneous fat removal and grafting for eyes that do not need fat removal at all, that should also be reconsidered.

5. Correction through under-eye fat removal based on an incorrect judgment

Fat removal is a surgery that removes orbital fat under the eyes when the under-eye area is protruding, flattening the protruded area.

When applied to dark circles, if the under-eye area is severely protruding and the skin over the protrusion has a reddish tone, fat removal can help reduce the redness while also making the under-eye area flatter.

However, if the under-eye protrusion is not severe and the person has dark dark circles, fat removal can cause the skin to contract and increase skin density, making the under-eye area even darker. If the under-eye area becomes generally sunken, the shadow effect can make it look darker, creating the opposite effect.

Because fat removal alone often does not produce treatment results, or may even worsen dark circles, it should only be performed when the exact surgical indication is met.

However, you should understand that there are clear limitations to solving dark circles with fat removal alone.

6. Incorrect indications for dark circle treatment

① Creating aegyosal with the wrong indication

The only cases in which dark circles can be treated by creating under-eye aegyosal are dark circles just below the eyelashes.

Creating aegyosal in this area can expand the skin and lighten the color, producing an effect that corrects the dark circles. However, if the under-eye area is dark overall, or if it is sunken, the shadow effect may become more pronounced and the under-eye area may look even darker.

Therefore, aegyosal should only be performed when the indication is correct.

② Micro fat grafting with the wrong indication

Fat grafting can only be applied when the under-eye area is at least somewhat sunken.

If the under-eye area is protruding due to excess fat, or if the eyes are flat, fat grafting can make the under-eye area protrude even more, creating the opposite effect.

Micro fat grafting can only be applied when the under-eye area is even slightly sunken.

Also, micro fat grafting under the eyes requires considerable skill and experience.

If fat is grafted clumsily, side effects such as an uneven under-eye area can occur, and the shape often looks awkward, so this is a region that requires caution.

Therefore, under-eye fat grafting is an area where the injector’s experience and know-how are most important.

③ Lower blepharoplasty with the wrong indication

Lower blepharoplasty is a surgery that pulls the skin under the eyes to smooth out wrinkles, and it can be applied to dark circles caused by many fine wrinkles under the eyes.

However, in reddish dark circles with thin skin, even if wrinkles are present, the reddish dark circles may become even more noticeable after surgery.

The reason is that pulling and smoothing the skin makes the skin even thinner, allowing the red muscle layer beneath the skin to show through more clearly.

Therefore, caution is needed when the skin is too thin, because lower blepharoplasty can make the redness under the eyes appear deeper.

7. How to administer vitamin C

When the skin under the eyes is thin, vitamin C can be administered in an attempt to thicken the skin, but the effect is less than expected.

The idea is to thicken the stratum corneum of thin skin so that the reddish orbicular muscle layer and blood vessels are not visible through it, but skin does not easily become thicker.

Because it is difficult to expect any effect beyond thickening the stratum corneum of thin skin, this should be seen only as a supplementary therapy for dark circle treatment, and it is difficult to say that this procedure alone treats dark circles.

Competitiveness of Duhan Plastic Surgery Dark Circle Clinic

​http://www.duhans.com​

There are dark circles that cannot be easily corrected depending on their shape, and the appropriate method for each person must be determined after a thorough examination.
As a clinic where procedures are performed by a board-certified plastic surgeon, we have more than 20 years of extensive clinical surgical experience with dark circles, ongoing research, and an aftercare management system.
The 5 STEP solution of Duhan Plastic Surgery Dark Circle Clinic focuses on accurate assessment and surgery for various dark circle symptoms. It is not just about removing dark circles; for younger and more beautiful eyes, we operate a dark circle combo program and an aftercare system for thorough management.
"More than 30,000 clinical surgery cases" Dr. Shin Duhan has more than 30,000 clinical surgery experiences to date, having specialized Duhan Plastic Surgery and its Dark Circle Clinic since the clinic opened.
"Trademark service rights registered for COL-FAT fat grafting" Through continuous research and development in fat grafting surgery, Dr. Shin Duhan obtained trademark service rights for COL-FAT fat grafting.
"Dr. Shin Duhan, recognized by the media" Domestic and international media are paying attention to Dr. Shin Duhan, a leader in the field of dark circles.
"Continuous research activities" New research findings on dark circles are being presented at domestic and international academic societies and seminars such as the International Society of Aesthetic Plastic Surgery and plastic surgery symposiums.

​http://www.darkcare.com​