Principles of Improving Under-Eye Dark Circles

Under-eye dark circle treatment know-how, a specialist with 20 years of experience

What is under-eye dark circle surgery?

▣ Under-eye dark circles is a general term for cases where the area under the eyes looks dark.

Under-eye fat grafting is a procedure that naturally fills in wrinkles or dark areas caused by hollows or depressions with fat grafts, helping to restore a brighter eye area.

▣ Under-eye depressed wrinkle lines refer to indented wrinkles that form shadows under the eyes.

They are different from fine lines, and because shadows create contrast, the under-eye area can look dark.

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

What causes under-eye dark circles?

These are various types of dark circles. Check whether you fall into any of the cases shown in the image above ㅠㅠ;;

Hollowing under the eyes (depression) - When the under-eye area becomes hollow, shadows appear and it cannot help but look dark.
If the skin is thin and the orbicularis oculi muscle underneath the eyes shows through - all muscles have a red color, so the orbicularis oculi muscle is also red.
High skin density - the higher the skin density, the darker the skin becomes and the more fine lines appear.
Deposition of skin melanin pigment - melasma, freckles, age spots, etc.

What is the principle of correcting under-eye dark circles with micro fat grafting?

1. As fat grafting corrects the hollow under the eyes, the dark shadow effect is reduced.

2. By expanding the skin, fine lines and skin melanin pigment can be lightened.

3. By placing yellow fat under the skin, the dark red color of the orbicularis oculi muscle can be diluted and lightened.

Since a red orbicularis oculi muscle layer is located beneath the under-eye skin layer, the main cause of most dark red under-eye circles is the projection of the color of this muscle layer through the skin.

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 project outward, allowing skin-tone color to project outward instead of red.

For this procedure to be performed, the under-eye area must be somewhat hollow.

Cases where fat grafting can be effective

It is suitable when the under-eye area is somewhat hollow.

If the under-eye area is not hollow but rather protruding, the under-eye orbital fat must first be removed before fat grafting is performed.

If fat grafting is performed on a protruding or flat 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 too many under-eye wrinkles

◇ Dark circles with sagging skin

What is the process of under-eye micro fat grafting?

1. Fat is harvested from areas where your own fat has accumulated, 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, moisture, etc.).

3. Oil is removed through a second refinement process.

Only when the oil is almost completely removed can it truly be called concentrated fat.

4. The refined fat is placed into a thin 1cc syringe.

Although there are individual differences, usually about one 1cc syringe is grafted into one eyelid.

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

We use a 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 within and above the orbicularis oculi muscle layer, creating a soft contour and a high graft survival rate.

6. After the procedure, you can resume daily life immediately, and washing the face is possible starting the next day.

Customized treatment is applied according to the cause of the dark circles, the type of dark circles, and the type of under-eye dark circles~ Director Shin Duhan's know-how in correcting under-eye dark circles for more than 20 years! Under-eye plastic surgery 5 Step! Under-eye Collpet fat grafting, scarless under-eye fat removal, under-eye fat repositioning surgery, micro fat grafting for under-eye aegyo-sal, lower blepharoplasty, under-eye blue vein dilation, and the know-how of under-eye surgery are not completed in a short period of time. Countless successful cases! Uncomparable, not a secret~~~~

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The causes of the dark circles above are twofold.

They are dark circles caused by shadowing from under-eye hollowness and by deposition of skin melanin pigment.

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 color to something closer to skin tone.

In other words, rather than black, the goal is to let skin tone show through via the fat.

The success of the procedure is determined by how smoothly and precisely the appropriate amount of fat is grafted.

The hollow wrinkle line under the eyes above is an nasolabial fold-shaped wrinkle line with no sagging skin at all.

To correct this, fat is grafted into the lower layer beneath the wrinkle-line skin, pushing the wrinkle up to the level of the surrounding skin tissue and smoothing it out.

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

From an experiential standpoint, the success of the procedure is determined by accurately judging and evenly injecting the proper amount of fat.

Examples of under-eye micro fat grafting applications

How many fat grafting sessions are needed?

★ How many fat grafting sessions are needed is determined by the fat graft survival rate.

Because this varies from person to person, the result of fat graft survival is checked after about 3 months before deciding.

In general, a second procedure is performed only if needed between 3 and 10 months after fat grafting.

Ultra-precise grafting is achieved using a special grafting cannula developed in-house!

★ In the under-eye area, the fat graft survival rate is higher than in other areas, so a satisfying result is often achieved with just one procedure.

Therefore, a second procedure is performed only when necessary, and cases requiring a third procedure beyond that are rare.

What are fat survival and fat graft survival rates?

| The survival rate of fat cells differs by area of the face. The higher the survival rate, the fewer procedures are needed and the greater the effect. A survival rate of 80% means that 80% of the total grafted fat survives and 20% is absorbed. Therefore, the higher the survival rate, the greater the corrective effect. | The area with the lowest survival rate is the lips, and the areas with the highest survival rate are the cheeks and the area around the eyes. The average survival rate after fat grafting is 50%. In other words, after grafting 100 units of fat, only 50% will remain after a few months. | The better the blood circulation in an area, the higher the fat survival rate. The area around the eyes has the best blood circulation on the face, so fat grafting there has a relatively high survival rate compared with other areas. Therefore, in many cases around the eyes, a permanent effect can be achieved even with a single procedure, but since repeat procedures are sometimes needed, if you think of it as being done about twice, you can expect a satisfying result. |

Collagen is naturally generated, creating youthful, elastic skin and contour~

When harvesting fat for a second fat grafting session

When fat is harvested from the lower abdomen or thighs, an adequate amount is collected for grafting, and any fat left over is not discarded but stored sterilely in a freezer.

The fat stored this way can be preserved for about 10 months, so if you visit within 10 months, you can receive a repeat procedure on the desired area.

Return to daily life after fat grafting?

​​You can resume activities immediately.

There may be some swelling and bruising, but the bruising is usually mild enough to be covered with makeup, so it does not cause major issues in social life.

If the swelling is severe, an anti-swelling injection can be given and the swelling subsides right away, so there is no need to worry about swelling.

Side effects of fat grafting

The side effects are limited to some swelling and bruising.

Other side effects can be said to be virtually nonexistent.

Some people worry that the under-eye contour may become uneven and bumpy, but this is related to the surgeon's experience and technique.

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

Under-eye procedures require delicate work and proper distribution of the right amount of fat to achieve good results.

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

To do this, subcutaneous tunneling is performed and a micro fat grafting cannula is used so that no incision is made under the eyes, and the proper amount must be delicately grafted into the hollow area to achieve good results without side effects.

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

The protruding-type dark circles improved after scarless fat removal at our clinic~~~

Let's look at methods other than fat grafting for improving dark circles~

Various fillers used in plastic surgery (Juvederm, Restylane, Perlane, Alloderm, Suhderm, Juvederm, Artecoll) are available and in use.

However, these filling materials have their own intended uses.

They are mainly used for fine wrinkles around the eyes, between the eyebrows, and on the forehead, or for correcting small depressed scars such as chickenpox scars.

If they are used incorrectly to correct under-eye hollows or dark circles, there is a high risk of side effects, and dark circles should not be corrected with these filling materials.

Micro fat grafting is the only method that can be effective for correcting under-eye hollows or dark circles.

In addition, although various procedures are performed in dermatology clinics to correct dark circles, the results are not satisfactory.

With representative whitening treatments and vascular laser treatments, it is difficult to expect therapeutic effects.

Also, if only the under-eye fat is removed, the under-eye area becomes hollow and the dark circles worsen, creating the opposite effect, so fat should not be removed carelessly.

Since dark circles caused purely by skin color are rare, whitening has almost no effect, and the effect of whitening is said to be turning dark skin into white skin, which would be like turning a Black person into a White person, so it is practically impossible.

Vascular laser treatment is also not a procedure that can change the color of the dark red muscle layer under the eyes, so no therapeutic effect can really be expected.

Because there is no realistic way to change the skin color and the color of the red muscle layer, experience shows that grafting yellow fat between the two layers is a good way to make the under-eye area appear closer to skin tone.

Frequently asked questions about dark circle treatment

Question) Which treatment method is the best for dark circles?

Answer) Dark circles have various shapes and patterns depending on the individual.

It is not possible to say that one method is better than another.

The appropriate treatment method differs for each person depending on the cause and symptoms.

In some cases, fat grafting must be performed, while in others the symptoms improve only when fat is removed instead. In some cases, lower blepharoplasty that removes skin is the only way to achieve a result.

In other words, it is important to perform the procedure that suits each person's eye area.

Question) I've heard that under-eye micro fat grafting makes the under-eye area bumpy and has many side effects. Is that true?

Answer) Under-eye fat grafting is not a procedure just anyone can perform.

As with all surgeries, the result depends on the surgeon's experience and know-how.

There are many hospitals that perform fat grafting, but the number that do it properly can be counted on one hand.

Fat grafting is easy to perform, but difficult to produce proper results.

People may think fat grafting is easy, but it absolutely is not.

In principle, fat grafting can only produce good results when performed accurately.

Fat grafting methods differ by hospital, and the outcome varies greatly depending on experience.

People may hear about or experience poor fat grafting and develop negative preconceptions, but when done properly, a single procedure can produce a satisfying result.

Question) How is under-eye micro fat grafting performed?

Answer) Under-eye fat grafting is one of the most delicate and highly difficult areas among fat grafting procedures.

Therefore, careless treatment can cause side effects.

To prevent side effects, every step of the process must be carried out precisely according to principle.

Fat should be harvested in the smallest possible particles, impurities completely removed, space for even fat grafting should be created through tunneling at the treatment site, and then the proper amount should be delicately and evenly grafted to obtain good results.

A special grafting cannula equipped with a micro needle about 1 mm in diameter is used for very precise treatment.

It is best to receive treatment at a hospital with professional know-how and many successful cases.

Question) Why did I undergo several pigment laser treatments but see no effect?

Answer) Pigment lasers are lasers that react to red color, and they are mainly good for people with red telangiectasia or skin with red erythema.

They are effective for redness in the skin itself, but applying them to red dark circles under the eyes is too much to ask.

The reason is that the cause of the redness is not in the skin itself but in the entire red muscle layer under the eyes.

No matter how much laser is applied to this red orbicularis oculi muscle layer, the color cannot be changed.

As long as the muscle is alive, the red color cannot change.

If all of the red muscle layer were burned away, the red color would disappear, but if it is burned enough to destroy the muscle, it would cause a major burn under the eyes and leave a scar, so removing the muscle layer with a laser is impossible and should not be done.

Question) I had fat removal, but my dark circles got worse. Why?

Answer) The main purpose of fat removal is to address protrusion under the eyes.

Sometimes the protruding area is accompanied by a hollow wrinkle below it, creating a shadow, and fat is removed in an attempt to eliminate this, but if done incorrectly it can easily have the opposite effect.

What happens when fat is removed is that the under-eye area becomes more sunken than before the procedure.

A sunken eye area creates a shadow effect and looks darker.

Also, when fat is removed, the skin contracts as it shrinks, which increases skin density and makes the skin color appear darker.

Fat removal is best performed when under-eye protrusion is severe and redness is strongly visible in the protruding area.

In most other cases, dark circles worsen, so caution is needed.

Question) How much improvement can I expect from under-eye micro fat grafting?

Answer) There are four effects of under-eye fat grafting.

It raises the depressed skin to eliminate the shadow effect, skin expansion from fat grafting can lighten the skin tone, fine lines improve during the process, and placing yellow fat underneath can dilute the dark red color and make it lighter.

Because symptoms differ from person to person, whether it will be effective can only be determined through an in-person examination.

Usually, the procedure is performed only when it is judged that a 50% to 90% improvement in dark circles can be achieved.

If the result is judged to be below expectations, it may be better not to perform the procedure at all.

The goal of fat grafting is not to completely eliminate the symptoms, but to reduce and improve the current dark circles as much as possible.

Question) Can under-eye micro fat grafting be done at any clinic?

Answer) The under-eye area is a very delicate region where fat must be grafted in tiny granule-sized amounts beneath thin skin.

Therefore, it differs from ordinary fat grafting in everything from selecting the harvest site to refinement and grafting.

Using a scarless micro fat grafting cannula and accurately and evenly grafting the proper amount determines the success of the procedure.

Without extensive experience and know-how, it is difficult to expect good results.

Poorly done under-eye fat grafting can produce results worse than not doing the procedure at all, so caution is needed.

Question) What about using fillers for hollow wrinkle lines under the eyes?

Answer) The skin under the eyes is very thin.

If the procedure is not carried out with great precision, it is difficult to obtain a satisfying result, and a bumpy contour after the procedure should not occur.

In the case of fillers, the color is transparent, making it difficult to create a natural skin tone, and it is difficult to create a soft contour after grafting.

A disadvantage is that if the shape looks awkward, it is very difficult to remove.

In contrast, fat grafting creates a natural skin tone while correcting dark circles and expressing a natural shape, so if performed delicately, bumpiness rarely occurs.

This is possible when the practitioner performs the procedure accurately.

Fillers are effective for improving fine lines around the eyes or on the forehead, but performing them under the eyes can cause many problems, so caution is required.

Question) How much swelling and bruising occurs after micro fat grafting?

Answer) Swelling and bruising vary from person to person, but they usually disappear after about 1 to 2 weeks.

The under-eye area has many blood vessels, so bruising inevitably occurs after the procedure.

Whether mild or severe, bruising cannot be avoided.

If bruising occurs, it must be covered with makeup until it disappears.

The procedure should be done with swelling and bruising in mind.

Question) Is a second fat grafting session always necessary after micro fat grafting?

The fat survival rate after grafting varies from person to person, but about 50% usually remains after around 2 to 3 months.

Sometimes the survival rate is good and more than 80% remains, and sometimes less than 30% remains.

Because the variables affecting survival depend on each person's constitution, it is only after about 3 months that it can be judged how much fat has survived.

The decision on whether to perform a second procedure is made based on the appearance after 3 months.

If the result of the first procedure is satisfactory, a second procedure is not necessary.

However, if the survival rate unexpectedly drops, a second procedure is sometimes performed.

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