Lower-eyelid fat repositioning moves bulging under-eye fat into the hollow groove instead of removing it, softening the under-eye contour.
When under-eye fat pushes forward and bulges, a groove forms just beneath it, and this contour casts a shadow that looks like dark circles. It is not that the skin is darker; the shadow comes from the height difference between the bulging and hollow areas. In such cases, removing the fat alone leaves the hollow behind, and over time the under-eye area can look even more sunken.
Lower-eyelid fat repositioning moves the bulging fat into the hollow groove (tear trough) and fixes it there, rather than cutting it away. The bulge is lowered and the hollow is filled, so the contour becomes smoother. Approaching through the conjunctiva on the inside of the eyelid avoids any skin incision, and this suits cases with little skin sagging.
At Atelier Plastic Surgery we separate the causes of dark circles into fat bulging and hollowing, skin sagging, pigmentation, and visible blood vessels. We recommend this surgery when fat bulging and hollowing are the main cause and the skin still has elasticity; if skin sagging is pronounced, we plan lower blepharoplasty. Consultation, surgery, and follow-up are handled personally by the director.
A small incision is made in the conjunctiva on the inside of the lower eyelid to reach the fat, and the bulging fat is moved below the under-eye groove and fixed. There is no skin incision, and recovery is relatively fast.
An incision below the lashes is used to move the fat and tidy a small amount of loose skin at the same time. This can address more excess skin than the conjunctival approach.
If the amount of fat to move is not enough to fill the hollow, autologous fat grafting is considered as well. This helps when the height difference between the under-eye area and the cheek is large.
These may vary depending on your condition; we will give you precise details at your consultation.
The solution differs depending on whether the shadow comes from contour, pigmentation, or visible blood vessels. Only shadows created by fat bulging and hollowing are addressed by this surgery, and at consultation we explain in advance how much improvement can be expected.
Removing a lot of fat may look smooth at first, but over time the under-eye area can hollow and look older. We preserve the fat and move it into the hollow groove, and when removal is necessary we remove only as much as needed.
If the skin still has elasticity, we work through the conjunctiva with no skin incision. If there is skin sagging, a conjunctival approach alone can leave excess skin, so in that case we recommend a skin incision or lower blepharoplasty.
If the height difference between the under-eye area and the cheek is large, repositioning alone may not reduce the shadow enough. Where needed we plan fat grafting alongside so that the contour flows naturally into the cheek.
Begin cold compresses and rest with your head elevated. You go home the same day; use the prescribed medication and eye drops. Avoid rubbing your eyes.
Swelling and bruising are at their peak. With a conjunctival incision, red swelling may be visible on the white of the eye, and it mostly subsides. Continue cold compresses.
Swelling decreases noticeably and daily activities are possible. If a skin incision was made, stitches are removed. You can wash your face.
Bruising has mostly faded and light makeup is possible. Start wearing contact lenses after discussing it with the director.
The moved fat settles, fine swelling resolves, and the contour softens. The firm feeling under the eyes gradually eases.
The final shape settles. Recovery speed and results vary from person to person.
Bleeding and hematoma, infection, swelling, bruising, and conjunctival swelling may occur. The moved fat may settle unevenly, causing lumpiness or asymmetry; fat may bulge again, or conversely too much may be moved, leaving the under-eye area looking puffy. Tearing, a foreign-body sensation, dry eye, and temporary double vision may occur, and if skin sagging is present, excess skin may remain visible after surgery. With a skin incision, incision-line scarring and, rarely, a change in eyelid position may occur. In rare cases, bleeding that affects vision can occur, so you must contact us immediately if you experience sudden pain or changes in vision after surgery. Revision surgery may be needed depending on the result, and outcomes vary from person to person. We explain the risks and limitations fully at consultation.
The content on this page is general medical information provided in accordance with the Medical Service Act. The results of surgery and treatments and the recovery period may vary by individual. All surgeries and treatments carry a risk of side effects, so please decide after a thorough consultation with a specialist.
Lower blepharoplasty that tidies loose skin and bulging fat and reinforces the supporting structure
Learn more Related Upper BlepharoplastyUpper blepharoplasty that removes only as much loose upper-eyelid skin as needed to improve both vision and appearance
Learn more Related Eye Surgery GuideA guide to choosing eye surgery by sagging, opening strength, and eye exposure
Learn more Related Academic ActivityPapers · books · conference lectures and chairs · society positions · ORCID
Learn moreConsultations are conducted by the Director herself. Schedule one by phone or KakaoTalk, or leave an online consultation request.
