AI-translated archive post
Duhan Plastic Surgery Clinic · 두한성형외과 DUHANISM · April 17, 2020
Under-eye fat removal # under-eye fat repositioning # under-eye fat repositioning surgery # under-eye sagging # sagging skin under the eyes # under-eye fat # removing under-eye fat...
AI translation notice
This page is an English translation of a Korean Naver Blog archive entry. For exact wording and source context, verify against the Korean archive original and the original Naver post.
Clinic: Duhan Plastic Surgery Clinic
Original post date: April 17, 2020
Translated at: April 25, 2026 at 6:30 AM
Medical note: This translation does not guarantee medical accuracy or suitability for treatment decisions.
Over 20 years of clinical experience and know-how
What is under-eye fat removal?!
Usually, there are three pockets of fat in the lower eyelid:
one pocket on the inner side of the eye, one in the middle, and one on the outer side.
Among these, the middle fat pocket is the largest, so the middle fat is removed, or, depending on the case, both the middle and inner fat may also be removed.
How much fat is removed and from which areas varies from person to person, so it is important to remove an appropriate amount for each individual.
Excessive fat removal can cause hollowing under the eyes, so the right amount of fat should be removed after an accurate examination.
Dr. Shin Duhan
What are the indications for under-eye fat removal?
A protruding under-eye area due to anterior displacement of orbital fat
Frequent morning swelling under the eyes
A hollow wrinkle line visible below the under-eye protrusion
Red dark circles under the eyes
What are the effects of under-eye fat removal?
| ▶ In the case of under-eye fat removal, the eye area is restored to a smooth look without contours, and hollow wrinkle lines under the eyes are corrected. |
|---|
| ▶ Red dark circles under the eyes can be improved. |
| ▶ The eyes are restored to a more youthful appearance. |
Anatomy of under-eye fat
What is the surgical process for under-eye fat removal?
The design is determined by deciding which area of fat to remove according to the distribution and amount of fat.
Sleep anesthesia is used to put the patient to sleep.
Then local anesthesia is administered again, but since the patient is already asleep, there is no pain at all.
A laser is sometimes used, but lasers have weaker hemostatic effects, so bleeding during surgery can be significant. For this reason, an electric coagulator is generally used more often.
The electric coagulator reduces bleeding, minimizing swelling and bruising.
Excessive fat removal can cause hollowness and wrinkles under the eyes, so it is appropriate to remove only the amount that comes out when pulled.
If hemostasis is insufficient, bleeding may occur from inside after surgery, resulting in significant swelling and bruising, so proper hemostasis is important.
Since dissolvable thread melts away within 7 to 15 days, there is no need to return later to have stitches removed.
Contact lens wear is also possible from the day after surgery.
After surgery, antibiotic and anti-inflammatory eye drops are used to prevent swelling and inflammation.
Examples of under-eye fat removal applications
What is the care after under-eye fat removal?
▷ After fat removal, use the cold pack provided by the hospital for about 3 days.
▷ On the day of surgery, you should sleep with your head elevated about 30 degrees to reduce bruising and swelling.
▷ To reduce swelling and bruising, avoid lying down as much as possible on the day of surgery and sit up when possible.
▷ Washing your face and wearing makeup are allowed from the next day.
▷ Contact lenses may be worn from the day after surgery.
▷ Use the eye drops prescribed by the hospital for about one week.
▷ Since the conjunctiva is closed with dissolvable thread, stitches do not need to be removed.
▷ Swelling and bruising are usually mild and subside almost completely within about a week.
What should be kept in mind after under-eye fat removal?
▷ Excessive fat removal can make the under-eye area look hollow, so care must be taken not to remove too much fat.
▷ If the skin is loose and under-eye fat removal is performed, the skin may sag and wrinkles may increase.
▷ If you have had LASIK, wait at least 3 months before undergoing under-eye fat removal; if you have had LASEK, wait at least 1 month.
▷ Under-eye fat removal may worsen dark circles in some cases, so if there is a risk of worsening dark circles, fat removal should not be performed.
What are the side effects of under-eye fat removal?
The most common side effects are those caused by the surgeon’s lack of experience: improper measurement of the amount of fat leading to excessive fat removal and hollowing under the eyes, more fine wrinkles than before surgery, or dark circles appearing or worsening.
It is better not to have plastic surgery at a dermatology clinic or other clinic run by someone who is inexperienced or not a board-certified plastic surgeon.
If hollowing under the eyes occurs after excessive fat removal, it can be corrected and restored with micro fat grafting.
To avoid side effects, it is important to identify the indications for fat removal through an accurate examination before surgery and remove an appropriate amount of fat.
If there is little skin elasticity and a tendency toward fine wrinkles, or if dark circles may worsen or appear, fat removal should not be performed.
To avoid side effects, the general rule is not to have surgery by someone who is not a plastic surgery specialist.
What changes in color can occur after under-eye fat removal?
Depending on the skin type under the eyes, there are roughly three kinds of color changes after fat removal.
There may be almost no color change, the color may become slightly darker, or the color may become lighter.
If there are dark circles under the eyes, the color often becomes darker after fat removal.
Conversely, if the color is red, the redness may decrease.
Depending on the skin type and current color, the color changes after fat removal should be predicted in advance and addressed accordingly.
If fat removal is performed with the goal of improving dark circles, it may actually worsen them, so the indications for the procedure must be carefully determined.
In some cases, if fat is removed to improve dark circles, an additional fat grafting procedure may later be needed beneath the area where fat was removed.
What should be known correctly about under-eye fat removal?
Some clinics perform under-eye fat removal with a laser, but there are facts that should be understood.
Some people mistakenly think the laser is an all-purpose, best surgical method.
When the under-eye area is incised with a laser, the problem is that there is significant bleeding after the incision.
The heat generated by the laser can stop bleeding from fine capillaries on its own, but for slightly larger blood vessels, hemostasis is not achieved, so if surgery is done only with a laser, the bleeding can make the operation impossible.
If surgery is to be performed with a laser, it should be done using an electric coagulator.
If there is bleeding, the laser should be stopped and surgery should continue while controlling bleeding with an electric coagulator.
There is no reason at all to perform the operation in such a complicated way.
If surgery is performed from the beginning using an electric coagulator, proper hemostasis can be achieved and the procedure can proceed quickly.
Despite the various disadvantages, some clinics still use lasers.
They are only trying to gain promotional effect for the clinic by mentioning the word “laser.”
By using the word laser, they want to give the impression that surgery will be better and encourage people to be more willing to proceed.
The laser used for fat removal is a carbon dioxide laser for incision.
Pigment lasers used to remove Ota’s nevus or tattoos can cost tens of millions of won, but a carbon dioxide laser is one of the least expensive lasers and is usually used to remove moles, freckles, and age spots.
The fact that a clinic has a carbon dioxide laser does not mean it has especially expensive equipment.
It should be understood as basic equipment that all plastic surgery and dermatology clinics have.
Our clinic also has a carbon dioxide laser, and it is mainly used only to remove moles and age spots.
It is not used for surgery.
Sometimes plastic surgery is performed at a dermatology clinic rather than a plastic surgery clinic.
A dermatology clinic is a department that treats skin diseases.
Dermatology is a field that has nothing to do with plastic surgery.
People sometimes confuse dermatology with plastic surgery.
Dermatology can be compared to internal medicine.
Internal medicine is the field that treats colds and internal diseases of the body with medication, and dermatology is also the field that treats skin diseases with medication.
A dermatologist holding a scalpel and performing plastic surgery is no different from an internal medicine doctor holding a scalpel.
It is common for patients to come to our clinic for correction after excessive fat removal and side effects from fat removal performed at a dermatology clinic.
In such cases, correction is again performed with micro fat grafting, but ideally such side effects should not be created in the first place.
As the saying goes, “medicine is for pharmacists and treatment is for doctors,” plastic surgery should be entrusted to a specialist in plastic surgery.
The main purpose of under-eye fat removal surgery is to correct the protruding contour under the eyes.
It is not primarily a surgery aimed at changing the color under the eyes.
In most cases, when fat is removed, the skin color changes due to skin contraction, but if too much fat is removed, the under-eye area becomes hollow and may look even darker.
Fat removal aims to remove an appropriate amount of fat to create a smooth eye area.
The color change after fat removal varies from person to person, but it does not often become lighter.
If the under-eye skin is thin and the red muscle layer underneath shows through, causing a reddish appearance, fat removal can reduce the redness.
However, in other cases, the color may become darker, so this must be kept in mind during surgery.
The color change after fat removal should be predicted before surgery to prevent problems afterward.
What are the frequently asked questions and answers about under-eye fat removal?
Question) What is the best method for under-eye fat removal?
Answer) Under-eye fat removal does not involve making an incision in the skin.
If an external incision is made, a scar remains, so in most cases, scar-free surgery is performed through the conjunctiva.
Question) How much swelling and bruising occur after under-eye fat removal?
Answer) There is some swelling and bruising, but they almost disappear within about a week.
Question) Do stitches need to be removed after under-eye fat removal?
Answer) Since the conjunctiva is incised, the fat is removed, and then the area is closed with dissolvable thread, there is no need to remove stitches.
Question) Does fat grow back after under-eye fat removal?
Answer) Fat that has once been removed does not regenerate.
Fat removal has a permanent effect.
Over 20 years of clinical experience and know-how
What is micro fat grafting under the eyes for correcting under-eye wrinkles and dark circles?!
This is a procedure used when the under-eye area is hollow or has sunken wrinkle lines,
and dark circles make the eyes look unattractive.
Fat is collected with a thin suction cannula from the lower abdomen or thighs,
then grafted into the under-eye area with a micro fat grafting cannula
to correct hollowness and wrinkle lines under the eyes and brighten the skin tone.
Dr. Shin Duhan
How can the eye area be made to look brighter and younger?
◆ Upper eye area - Usually, double eyelid surgery is performed to make the eyes appear larger visually.
Fat grafting is performed on sunken eyelids to restore a hollow eye area.
◆ Lower eye area - Through fat grafting, a plump aegyo-sal can be created under the eyes, or hollow wrinkle lines and dark circles can be corrected to make the area look brighter and younger.
What types of dark circles under the eyes are there?
What are the causes of dark circles?
① Hollowing under the eyes - When the under-eye area is sunken, a shadow effect occurs, and it inevitably looks dark.
② Color of the orbicularis oculi muscle under the eyes - The muscle around the roots of the hair can also have a red tone, so the orbicularis oculi muscle may appear red.
③ High skin density - The denser the skin, the darker the skin appears and the more fine wrinkles there are.
④ Deposition of melanin pigment in the skin - melasma, freckles, age spots, etc.
What is the principle of correcting dark circles with micro fat grafting?
Beneath the under-eye skin layer is a red orbicularis oculi muscle layer, so one of the main causes of dark reddish dark circles is the projection of the color of this muscle layer through the skin.
| ■ Fat grafting corrects hollowness under the eyes and reduces the dark shadow effect. |
|---|
| ■ By expanding the skin, fine wrinkles and skin melanin pigment can be made lighter. |
| ■ By placing yellow fat beneath the skin, the dark reddish tone is diluted and lightened. |
The principle of the procedure is to delicately graft yellow fat into the muscle layer or just above it so that the red color of the muscle layer does not show through, allowing skin-colored tones to appear instead of red.
For this procedure, the under-eye area must be somewhat hollow for the treatment to be possible.
When can under-eye fat grafting be effective?
Micro fat grafting under the eyes is suitable when the under-eye area is somewhat hollow.
If the under-eye area is not hollow but instead protruding, the orbital fat under the eyes should first be removed before fat grafting. If fat grafting is done in a protruding or flat area, the under-eye area may look even more protruded, which can have the opposite effect.
When is under-eye fat grafting not effective?
□ Dark circles with a protruding under-eye shape
□ Cases with excessive under-eye wrinkles
□ Dark circles with severe sagging skin
What is the micro fat grafting method for attractive eyes?
| 1. Fat is harvested from areas where a lot of your own fat is stored, such as the lower abdomen, waist, or thighs.* Because local anesthesia (painless sleep 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, oil, blood, serum, water, etc.). |
| 3. Oil is removed through a two-step purification process. 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 person, usually about half to one 1cc syringe is grafted into one eyelid. |
| 5. A micro fat grafting cannula is inserted along the planned under-eye design line to perform the grafting.Our clinic uses the micro-needle (micro grafting cannula) developed in-house.The micro-needle is a special grafting cannula used only by our clinic, enabling ultra-precise grafting.The graft is placed inside and above the orbicularis oculi muscle layer, creating a soft contour and a high take rate. |
| 6. After grafting, you can return to daily life immediately, and washing your face is possible from the next day. |
How well do you understand micro fat grafting under the eyes?
Anatomy of dark circles and understanding fat grafting under the eyes
There are two causes of dark circles in the photo above.
One is a shadow formed by hollowing under the eyes, and the other is dark circles caused by the deposition of melanin pigment in the skin.
To correct this, micro fat grafting is performed to eliminate the shadow effect and allow more light to enter, and yellow fat is placed between the orbicularis oculi muscle layer and the skin to dilute the black tone toward a skin-colored appearance.
In other words, the goal is to make the yellow fat, rather than the dark skin tone, appear as the skin color.
The success of the procedure depends on how smoothly and precisely an appropriate amount of fat is grafted.
Anatomy of hollow under-eye wrinkles and understanding fat grafting
The hollow under-eye wrinkle in the photo above is a nasolabial-type wrinkle line with no sagging skin at all.
To correct this, fat is grafted beneath the wrinkle line skin layer to push the wrinkle up to the same level as the surrounding skin tissue and smooth it out.
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 using a micro fat grafting cannula without making any incision in the skin.
The success of the procedure depends on the surgeon’s experienced judgment and how evenly an appropriate amount of fat is injected.
Examples of under-eye micro fat grafting applications
What is the effect of under-eye fat grafting on dark circles?
Dark circles refer to a condition in which the skin under the eyes becomes dark or dark reddish, making the eye area look dull.
In some cases, the skin tone changes; in others, the skin wrinkles contract excessively, creating many fine wrinkles that make the area look dark.
In other cases, the red muscle layer beneath thin skin shows through and appears reddish.
Although fat grafting cannot change the skin color itself, in cases where dark circles are caused by skin contracting like an elastic band, creating aegyo-sal can expand the skin and make it look lighter. In cases of dark reddish circles caused by the visible muscle layer, grafting fat beneath the skin provides color compensation between the yellow fat and the dark bluish tone, helping the skin appear lighter.
How many under-eye fat grafting sessions are needed?
The number of fat grafting sessions depends on the fat survival rate.
Because this varies from person to person, the result after about 3 months is checked before deciding.
If needed, a second procedure is performed between 3 and 10 months on average.
Since the survival rate of fat in the under-eye area is higher than in other areas, many people are satisfied after just one procedure.
Therefore, a second procedure is performed only when necessary, and third procedures are very rare.
What are the take and survival rates for under-eye fat grafting?
Fat cell survival rates differ by area of the face.
The higher the survival rate, the fewer procedures are needed and the greater the effect.
For example, a survival rate of 80% means that 80% of the total transplanted fat survives and 20% is absorbed.
Therefore, the higher the survival rate, the greater the corrective effect.
Areas with the lowest survival rate are the lips, and the areas with the highest survival rate are the cheeks and around the eyes.
The average survival rate after fat grafting is 50%.
In other words, after grafting 100 units of fat, only 50% remains after several months.
The better the blood circulation in an area, the higher the fat survival rate. Since the eye area has the best blood circulation on the face, its survival rate after fat grafting is relatively high compared with other areas.
Therefore, around the eyes, a permanent effect can often be achieved with just one procedure.
However, since repeat procedures are sometimes needed, it is reasonable to think of it as requiring about two treatments to achieve a satisfactory result.
Is fat harvested again for a second fat grafting procedure?
When fat is harvested from the lower abdomen or thighs, enough fat is collected for the graft, and the excess is not discarded but frozen and stored under sterile conditions.
Fat stored in this way 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 back for a second procedure after 10 months, fat must be harvested again for the treatment.
When can activities be resumed after fat grafting?
Exercise such as walking, stretching, or weight training is possible even immediately after the procedure, but running should be avoided for about a month to improve the fat survival rate.
You can resume daily activities right away.
There may be some swelling and bruising, but it is usually manageable with makeup, so it does not cause major problems in social life.
If swelling is significant, an anti-swelling injection can be given and the swelling will go down right away, so there is no need to worry too much about it.
What are the side effects of under-eye fat grafting?
The side effects are limited to mild swelling and bruising.
There are essentially no other side effects.
Some people worry that the contour under the eyes may become uneven or lumpy, but this is related to the surgeon’s experience and skill.
Therefore, under-eye fat grafting requires extensive experience and know-how, and it is not a procedure just anyone can do.
A delicate procedure and even distribution of an appropriate amount of fat are necessary to achieve good results.
Ultimately, the success of the procedure depends on how well the surgeon performs it.
For this reason, subcutaneous tunneling is performed, and a micro fat grafting cannula is used so that no incision is made under the eyes and the appropriate amount is precisely grafted into the hollow areas to achieve good results without side effects.
Also, if an awkward shape occasionally appears, the surgeon must have the ability to correct it simply and immediately.
What are other methods besides fat grafting?
Of course, various fillers used in plastic surgery are available and used (Juvederm, Restylane, Perlane, Alloderm, Surederm, Juvederm, Artecoll).
However, these filling materials have separate intended uses.
They are products used for fine wrinkles around the eyes, between the eyebrows, and on the forehead, or for small depressed scars such as chickenpox scars.
If used incorrectly to correct hollows under the eyes or dark circles, there is a high risk of side effects, and these filling materials should not be used to correct dark circles.
Only micro fat grafting is effective for correcting under-eye hollows or dark circles.
In addition, although various procedures are performed at dermatology clinics to improve dark circles, it is true that the results are not satisfactory.
It is difficult to expect therapeutic effects from representative whitening treatments or vascular laser treatments.
Also, simply removing under-eye fat can make the under-eye area hollow, creating the opposite effect and worsening dark circles, so fat should not be removed carelessly.
Since dark circles caused purely by skin color are rare, whitening treatment has little effect; moreover, whitening would mean turning dark skin white, which is like saying a Black person can be turned into a White person, and is not realistically possible.
Vascular laser treatment is also not a procedure that can change the color of the dark reddish muscle layer under the eyes, so no treatment effect can be expected.
Because there is no way to change the skin color and the reddish muscle layer color, grafting yellow fat between the two layers is an effective way to make the under-eye color closer to skin tone.
Over 20 years of know-how
What is under-eye fat repositioning?!
Instead of removing the orbital fat under the eyes,
this refers to moving and spreading the fat below the protruding area.
This method is intended to correct both the protruding area and the hollow area at the same time.
It was designed to compensate for the drawback of fat removal,
which can address the protruding area but not the hollow area.
Dr. Shin Duhan
Who is a candidate for under-eye fat repositioning?
It is for cases where protruding orbital fat under the eyes is accompanied by hollow wrinkle lines.
It is for cases where protruding orbital fat under the eyes is accompanied by hollow wrinkle lines.
What are the advantages of under-eye fat repositioning?
○ Improvement of dark circles
○ Correction of puffy-looking eyelids
○ Prevention of the sunken appearance that can occur after excessive under-eye fat removal
○ Correction of under-eye wrinkles along with restoration of a smooth eye area
○ No scar and a natural result
What is the surgical method for under-eye fat repositioning?
The loose fat pocket is removed through the conjunctiva, moved onto the bone under the eye, and fixed so that it does not move.
What is the difference between lower blepharoplasty and under-eye fat repositioning?
| Lower blepharoplasty | Comparison | Under-eye fat repositioning |
|---|---|---|
| Incision in the skin under the eyes | Procedure area | Inner conjunctiva of the eye |
| A slight scar remains | Scar | Almost none |
| Disappears | Aegyo-sal under the eyes | Preserved or created |
| Exists | Wrinkle removal | None |
| Surgery not possible | Whether surgery can be performed in keloid patients | Surgery possible |
What are the problems with under-eye fat repositioning?
The biggest issue is that it is difficult to achieve the desired result properly.
Because the surgery is performed through the conjunctiva, visibility is limited and the operation cannot be done properly. Also, there are not many patients for whom fat repositioning is a perfect fit.
To give a simple example, if the goal is to level land that has both a hill and a puddle by removing soil from the hill to fill the puddle, then if the hill is not very large, even after removing all the soil from the hill, there may still not be enough to fill the puddle, and after filling it, the hill may instead become a hollowed-out puddle.
This is what happens when fat volume is limited and the fat is forcibly pulled and repositioned: the area that was protruding can instead become sunken.
In another case, the puddle is larger than the hill, so even after shaving off all the soil from the hill to fill the puddle, the depth of the puddle may be slightly reduced but it still remains a puddle.
This means that the small amount of fat was pulled and repositioned, but the hollow area was not corrected well and remains hollow.
In yet another case, the hill is large, so even after filling the puddle, the hill only becomes slightly smaller and still remains a hill.
This means there is a lot of protruding fat, and even after repositioning, fat remains and the under-eye protrusion is still there.
What are the four points of dissatisfaction with under-eye fat repositioning?
When performing fat repositioning, surgery must be done only after carefully determining the appropriate shape and indications in order to achieve a satisfactory result. If the procedure is performed in cases that are not suitable, it may become an awkward operation that is neither one thing nor the other.
| 1. When there is insufficient fat, the protruding area where the fat was may instead become sunken after fat repositioning |
|---|
| 2. When there is a large amount of fat, the original protruding area may still appear protruded even after fat repositioning |
| 3. After fat repositioning, the original hollow area may instead appear protruded |
| 4. When there is a small amount of fat, the original hollow area may not be filled properly after fat repositioning and may still appear hollow and shadowed |
Another issue is that more tissue has to be dissected than in fat removal surgery, so swelling and bruising are much more severe.
If the indication does not fit, fat removal can provide a more definite result than fat repositioning, and if needed, micro fat grafting can be additionally performed to fill the hollow area after fat removal.
| Under-eye fat repositioning is mostly unsatisfactory or awkward when applied carelessly to patients who do not have much orbital fat.Also, little improvement in under-eye color can be expected from fat repositioning; it is mainly performed for contour correction.However, cases in which the desired flat under-eye area is actually created are extremely rare.There are many cases at other clinics where fat repositioning is recommended even for eyes with little or no under-eye fat protrusion, and this should be reconsidered.After under-eye fat repositioning, rather than becoming flatter, the under-eye area may instead become hollow or protruded, leading patients to ask our clinic for correction. If it becomes hollow, it can be corrected again with micro fat grafting. |
The culmination of 20 years of fat grafting know-how~
Continue browsing
Return to the source archive for more translated posts, or open the Korean clinic profile to compare other public channels.