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Let's take a look at the causes of dark circles~

1. Cause: the orbicularis oculi muscle or blood vessels underneath thin skin show through

Dark circles do not occur on the cheek fat area of the face.

The reason is that the skin layer is thick and there is a yellow fat layer beneath the skin.

The yellow fat layer is the main element that gives skin its color.

However, unlike the cheek area, the skin under the eyes is often as thin as paper, and the structures underneath can show through the thin skin layer. That structure is the red orbicularis oculi muscle.

Even in the same person, the color of dark circles changes depending on skin thickness.

If the skin is thin, the structures beneath it show through and create reddish dark circles; conversely, if the skin is thick, reddish dark circles do not appear.

The orbicularis oculi muscle is the muscle that wraps around the eyes, and because muscles are naturally reddish, this muscle layer beneath the skin is projected and visible, causing reddish dark circles.

In addition, many tiny blood vessels are distributed throughout the muscle layer, which also contributes to the redness.

However, if the skin contracts too much and its density becomes high, fine wrinkles form and the color becomes a brown dark circle caused by melanin.

Therefore, the appearance of dark circles is greatly affected by skin thickness.

2. Cause: dark appearance due to shadows from under-eye concave wrinkles

People with hollow under-eyes look darker than those with a flat or protruding eye area.

The reason is that recessed areas receive less sunlight, creating a shadow effect.

If concave wrinkle lines are also present, the shadows follow the wrinkle lines and create more distinct light and dark contrast, making the under-eye area look even darker.

However, darkening caused by light and shadow can be reduced naturally by filling the area underneath the skin with fat so that the height becomes closer to the surrounding area, which removes the shadow and contrast.

The key point is the principle of filling a recessed area that does not receive enough light so that more light can enter.

3. Cause: skin melanin pigmentation

Melanin pigment is distributed throughout the skin.

When melanin density is high, the skin looks darker, and when density is low, the skin looks brighter.

It can also cause the under-eye area to look dark due to spots caused by excess melanin.

These spots can sometimes be treated with lasers, but not always.

There are various skin conditions caused by melanin pigmentation, such as melasma, freckles, age spots, and moles, but the ones that can be treated with lasers are limited to shallow moles or age spots.

It also tends to recur easily, and in many cases treatment can actually worsen symptoms due to scarring from the laser or laser-induced pigmentation. For that reason, treating dark circles with lasers has considerable limitations in terms of indications.

Whenever possible, it is better to treat the area with a method that does not irritate the skin.

If the under-eye area is somewhat hollow, micro fat grafting can help reduce the dark color.

4. Cause: high skin density

Skin is like a rubber band: it stretches when pulled and contracts when released.

Because of this, if the skin contracts excessively and its density increases, tiny fine wrinkles cluster tightly together like silkworm pupa wrinkles, making the skin appear darker.

The reason the skin looks darker is that normal skin melanin becomes more concentrated per unit area due to the excessive crowding of the skin.

In this case, the skin needs to be spread out to lower the density. If the symptoms are mild, fat grafting can be used to expand the area, but in severe cases, correction may require lower blepharoplasty that removes some skin.

Which method is appropriate should be determined according to the severity of the symptoms.

Let's look at the types of dark circles~

Types of dark circles by cause

1. Reddish dark circles caused by protruding fat

These are dark circles that occur when orbital fat bulges out and the red orbicularis oculi muscle under the eye shows through the skin.

This is a phenomenon accompanied by thin skin and protrusion of orbital fat.

In such cases, fat removal can help reduce the redness under the eyes to some extent.

2. Shadow-type dark circles caused by under-eye hollowness

When the under-eye area is recessed compared to the surrounding tissue, it looks darker because of shadows and contrast.

To prevent shadowing, the recessed area should be filled with fat up to the level of the surrounding skin so it is raised.

Then the shadow disappears and more light enters, making the under-eye area brighter.

3. Fine-wrinkle-type dark circles caused by high skin density

If skin density is too high, many fine wrinkles occur.

When tiny skin wrinkles cluster tightly together like silkworm pupa wrinkles, the number of skin melanin pigments occupying a unit area also increases, making the skin appear darker.

In this case, the skin needs to be expanded to reduce the density. If the under-eye area is somewhat hollow, the symptoms can be improved by expanding it with fat grafting, or by performing lower blepharoplasty to remove part of the skin.

4. Dark circles caused by excess melanin pigmentation

The skin contains a black pigment called melanin.

When this accumulates in large amounts, it forms moles, freckles, melasma, age spots, and so on.

Melanin pigment often gathers under the eyes and becomes visible through the skin tone.

In such cases, age spots or freckles can be removed with peeling lasers.

However, in cases of overall pigmentation under the eyes, procedures are often difficult.

When the under-eye area is somewhat hollow, fat grafting can be used to dilute the dark color by adding the yellow tone of fat to the skin color.

5. Dark circles caused by projection of the orbicularis oculi muscle and blood vessels through thin skin

When the skin under the eyes is thin, the red orbicularis oculi muscle layer directly beneath the skin becomes visible.

This orbicularis oculi muscle is the muscle that wraps around the eyes in a circle and mainly plays a role in creating eye-area expressions, but because its color is reddish, it shows through the thin skin beneath the eyes.

By performing fat grafting and laying down a thin layer of yellow fat, the red tone can be diluted with yellow and the color can be lightened.

Types of dark circles by color

1. Black dark circles

These are mainly caused by high skin density, shadowing from under-eye hollowness, or skin melanin pigmentation.

High skin density creates fine wrinkles, increasing the number of melanin pigments per unit area and making the under-eye area darker.

2. Reddish dark circles

Most reddish dark circles are caused by the red orbicularis oculi tissue beneath thin skin showing through.

Reddish dark circles account for a significant portion of dark circles.

Because all muscles are reddish in color, in the under-eye area where the skin is as thin as paper, the red orbicularis oculi muscle layer becomes visible through the skin.

If there is a large amount of orbital fat beneath the muscle layer and it protrudes, the redness becomes more noticeable.

3. Dark red mixed-type dark circles

These are cases where reddish dark circles and black dark circles are mixed, and this mixed type is the most common.

This occurs when the skin is thin and melanin pigmentation is present, and the treatment method is determined by which cause is the main one.

The most common form is a mixed type in which a reddish dark circle caused by thin skin is combined with some melanin.

Under-eye dark circles negatively affect the image of the eye area, so improving them can sometimes be more effective than having double eyelid surgery.

There are various treatments, but in reality most produce less-than-expected results.

The weakness of treatment is that procedures are performed without identifying the exact cause.

People often try pigment laser treatment, but pigment lasers are used for capillary dilation or redness of the skin itself, and they have almost no effect on the red orbicularis oculi muscle layer beneath the skin, which is the cause of reddish dark circles.

The same applies to skin whitening agents.

Whitening agents can affect the skin itself, but they also have limitations in treatment.

In addition, in cases where dark circles are caused by the orbicularis oculi muscle layer showing through, they are often completely ineffective.

Making the red muscle layer less visible is the most helpful approach to treatment. In theory, it is better to thicken the skin so the muscle layer does not show through, but in reality there is no suitable way to increase skin thickness.

As an alternative, one can choose a method that places a substance beneath the skin layer so the muscle layer is hidden, and the best option is fat grafting.

Because fat is yellow, it can express a natural skin tone, and it also covers the red muscle layer, diluting the red color and making it lighter.

However, this can be applied only when the under-eye area is hollow. It is difficult to apply when the under-eye area is flat or, conversely, protruding.

If you absolutely want fat grafting for a protruding eye area, the orbital fat can be removed first and fat grafting can be done afterward.

At our clinic, rather than injecting a large amount into one place through a tunneling technique, we perform three-dimensional micro fat grafting with 100% concentrated fat distributed evenly across multiple layers.

The fat grafting procedure at Duhan Plastic Surgery Dark Circle Clinic also includes a process called "tunneling," which helps the grafted fat make maximum contact with the abundant surrounding blood vessels so it can continuously receive nutrients.

Tunneling means using micro-needles just beneath the skin to create space for the fat. In other words, space is made as if a tunnel is being drilled, and then the fat is injected, so even after all the fat has been placed it does not sag downward or become lumpy due to gravity.

In addition, the procedure uses micro fat grafting with fine cannulas, allowing customized design through delicate injection methods.

The effects of under-eye fat grafting are fourfold.

It raises sunken skin to eliminate shadowing, can lighten skin tone by expanding the skin through fat grafting,

improves fine wrinkles, and can dilute dark reddish tones by laying down yellow fat.

After fat grafting, some swelling and bruising occur, but they are not severe.

Daily life is possible from the same day, and washing the face and makeup are possible from the next day.

Which method to choose depends on the practitioner’s experience and on identifying the exact cause first, then performing the appropriate procedure.

A careful review is needed to decide whether fat should be removed, fat should be grafted, or lower blepharoplasty should be performed. If a procedure is done for the wrong indication, there may be little effect or even an adverse result, so the practitioner’s experience is extremely important.

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Features and pride of

Duhan Plastic Surgery Dark Circle Clinic

Since opening in 2001, designating dark circles as a specialized surgical item has been an expression of confidence in dark circle treatment.
Since opening, we have continued research and conference presentations, and as a result we have become a hospital with extensive know-how.
As a leader in dark circle treatment, we are proud to lead a new paradigm in the dark circle field.
1:1 customized surgery by type Dark circle surgery can be performed at any hospital, but there are not many hospitals that accurately analyze the patient’s type and precisely choose the right surgical method. Dark circle surgery may seem easy, but it is not an easy procedure. Our clinic is highly experienced, with extensive dark circle treatment experience and answers for various types.
Accurate analysis of the various types of dark circles is essential.
The surgical method must change according to the symptoms of the dark circles. Surgery must consider the muscles, skeleton, and skin in the dark circle area.
We provide continuous care through an after-care system, taking responsibility to the end for beauty.
We have extensive clinical surgical experience. In general, people think dark circles are solved by removing or filling fat. That is true in principle, but how and how much fat should be removed, and where the appropriate amount should be filled, can only be answered through long surgical experience.
Duhan Plastic Surgery Dark Circle Clinic has registered the trademark service rights for "COL-FAT" fat grafting as a result of long-term continuous research. COL-FAT fat grafting was achieved through Duhan Plastic Surgery’s fat grafting method and long-term research. COL-FAT fat grafting is the intellectual property of Duhan Plastic Surgery.
In general, many people only need dark circle surgery, but the ultimate goal is to pursue beauty. In line with this need, Duhan Plastic Surgery Dark Circle Clinic operates a dark circle combo program. The dark circle combo program combines dark circle surgery with procedures that are beneficial to perform together, creating a greater effect.
We also provide continuous care after surgery. After surgery, side effects and swelling that may occur due to insufficient patient care can be managed through the after-care system. A hospital that takes responsibility for one connection to the end! That is Duhan Plastic Surgery.
Dark circles are not simply a matter of removing and repositioning under-eye fat. They must be treated by considering the amount of extra skin, the degree of muscle sagging, and even the bone structure surrounding the eyeball, so an experienced specialist can create good results by knowing what shape the eyes will take after surgery. With 20 years of experience and know-how, a board-certified plastic surgeon personally provides care. Duhan Plastic Surgery Dark Circle Clinic has designated this as a key treatment area since the clinic opened and has studied and developed it for 18 years. As various medical fields have advanced, dark circle surgery has also made great progress. Duhan Plastic Surgery Dark Circle Clinic is also keeping pace by acquiring and developing new medical knowledge and techniques, leading a new paradigm in the dark circle field.

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