Lower Eyelid Fat Repositioning to Erase Dark Under-Eye Shadows
Three-Line Summary
Below, we describe in order the definition, who it is for, causes, process, recovery, and side effects. You may start with whichever item you are curious about.
Other surgeries around the eyes are covered in Causes of Droopy Eyes and Criteria for Choosing Surgery.
Lower eyelid fat repositioning is a surgery that, rather than removing the fat bulging under the eye, moves it to the hollow area below (the tear trough) to smooth the border between the under-eye area and the cheek.
In a word, it is a surgery that uses the fat by moving it rather than discarding it.
The bulging area is lowered and the hollow area is filled. The aim is to smooth the border between the under-eye area and the cheek.
In the medical literature, it is treated as one method of lower blepharoplasty. The name used in the literature is fat repositioning (or fat transposition)[1].
Several surgeries have similar names, which makes them easy to confuse. First, we will sort out what each is called.
In the medical literature, both surgeries are covered within the scope of lower blepharoplasty. At our clinic, surgery that cuts away skin is called lower blepharoplasty, and surgery that goes in from inside the conjunctiva to move fat is called lower eyelid fat repositioning.
There is literature describing this technique[1]. It is an approach through the conjunctiva (the mucous membrane inside the eyelid). The herniated lower eyelid fat is repositioned toward the nasojugal fold (the groove that runs diagonally from the inner eye toward the cheek)[1]. This literature used tear-trough deformity as a synonym for nasojugal groove[1]. There is also another review (a paper that compiles and explains multiple publications) on lower blepharoplasty. This review states that the procedure is based on selective excision and repositioning of fat[2].
In plain terms — the surgeon goes in from the inside of the eyelid. The pushed-out fat is placed into the hollow groove just below. The medical literature used that groove as a synonym for the tear trough. Some literature summarizes that selectively removing or moving fat is the basis of lower eyelid surgery.
The purposes differ. Surgery that removes fat aims to reduce the bulge. Surgery that moves fat is different. It aims to reduce the height difference between the bulging area and the hollow area.
Picture a hill and a valley. Removal is like shaving down the hill. Moving is like using the hill's soil to fill the valley just below.
Removing fat reduces the protruding part. However, the lower area that was originally hollow remains as it is.
This does not mean that one is better than the other. Some under-eyes only bulge, and some have a hollow beneath the bulge as well. They are simply different conditions. Which one your under-eye is will be confirmed at the examination.
A Word from the Doctor
"Lower eyelid fat repositioning or lower eyelid fat removal… many people agonize over which to choose, and the decision is made to suit each person's situation after a thorough examination."
Whether part of the fat is also reduced while it is moved:
When the area under the eye bulges, you look tired and older. What actually protrudes is the under-eye fat, but the under-eye groove beneath it can also look hollow, as if sunken. For younger people or those with little skin sagging, lower eyelid fat removal or lower eyelid fat repositioning is usually performed, and because no skin is cut away, surgery can be done without a visible skin incision on the outside.
Under-eye surgery is considered to correct this, and there are various methods such as lower eyelid fat removal, lower eyelid fat repositioning, and lower blepharoplasty. Smooth out shadowed under-eyes! This is Face Plus's under-eye surgery know-how for completing a brighter impression.
※ This condition differs from person to person and can be determined after a close and careful examination.
It is done when the area under the eye bulges and the area just below is hollow, casting a shadow at the border.
Read this while picturing the under-eye area in your mirror. If any of these apply, we will check at the consultation.
The two surgeries are similar in location and name. There is one criterion for telling them apart.
The criterion for telling the two surgeries apart is whether the lower eyelid skin has stretched and is in excess.
If there is almost no excess skin and only the fat bulges, lower eyelid fat repositioning, which goes in through the conjunctiva on the inner side of the eyelid to move the fat, is considered first.
If the skin has stretched and is in excess, lower blepharoplasty, which cuts away skin, is considered. In this case as well, the bulging fat is addressed together.
Whether there is excess skin is hard to judge in a mirror. At the examination, we pinch the skin directly. We also check the strength that supports the lower eyelid.
Lower blepharoplasty is explained in Lower Blepharoplasty information.
One fills; the other moves.
Filler is a procedure that fills the hollow area by injection. The protruding fat is left as it is.
Lower eyelid fat repositioning is a surgery that moves the protruding fat itself into the hollow area.
Filler is explained in Filler procedure information.
It is because the fat that supports the eyeball is pushed forward as the membrane that used to hold it back loosens.
Some people are told they "look tired" even after a good night's sleep. In that case, the cause may not be fatigue. It may be fat that has been pushed forward from where it was.
Around the eyeball there is fat that supports the eyeball. It surrounds the eyeball like a cushion. In front of this fat is a thin membrane. This membrane holds the fat in place.
When this membrane loosens, the fat is pushed forward. This is why the area under the eye looks bulging in the mirror.
Just below the bulging area there is a groove. It is the groove that runs from the inner eye to the cheek. It is called the tear trough.
If this groove is hollow, the height difference grows larger. A shadow forms at that border.
Sometimes it develops with age. Sometimes it is present from a young age. It is not necessarily just due to age.
Inside the lower eyelid there is orbital fat (the fat around the eyeball). In front of it, the orbital septum (the thin membrane that blocks the front of the fat) holds it back. When the orbital septum and surrounding supporting tissue loosen, the orbital fat herniates (is pushed out) forward. The lower eyelid then bulges. Below that lies the tear trough (the indented line at the inner under-eye). If the tear trough is depressed, a step (height difference) forms between the protruding and depressed areas. That step creates a shadow.
In plain terms — the membrane that held the fat back has become loose, and the fat has come forward. If the area just below is hollow, that height difference creates a shadow.
It will not get rid of all of them. What this surgery changes is the shadow created by the bulging fat and the hollow area.
You have probably heard "Your dark circles are bad lately" at least once. But there is more than one reason the under-eye looks dark.
| Cause of the dark look | Changed by lower eyelid fat repositioning? |
|---|---|
| Shadow cast beneath protruding fat | This is what this surgery addresses |
| Color of the skin itself (pigmentation) | Not changed |
| Blood vessels showing through thin skin | Not changed |
Sometimes all three are mixed. If the main cause is pigment or visible blood vessels, darkness remains even after surgery.
That is why we first sort out the cause at the consultation.
A Word from the Doctor
"One of the usual causes of dark circles is bulging under-eye fat. The area beneath the protruding fat falls into shadow and looks darker. In this case, surgical correction can improve it. If the skin is pigmented, or the skin is so thin that what lies beneath shows through and looks like dark circles, surgery cannot improve it."
Surgery takes about 1 hour under local anesthesia or sedation. Hospitalization is not required.
Since it may feel vague the first time, we have laid it out step by step.
| Step | Details |
|---|---|
| 1. Design | The bulging and hollow areas are marked |
| 2. Anesthesia | Local anesthesia or sedation is given |
| 3. Incision | The conjunctiva (the mucous membrane inside the eyelid) is incised |
| 4. Moving the fat | The protruding fat is moved to the hollow area below (the tear trough). How the moved fat is secured is explained at the consultation |
| 5. Finishing | When the approach is from inside the eyelid, there are no outer stitches to remove |
| 6. Going home | Hospitalization is not required |
With the approach through the conjunctiva on the inner side of the eyelid, the incision line is on the inside of the eyelid. No incision is made in the outer skin.
It is natural to worry about marks on the face. The incision site is on the inner side, visible only when the eyelid is turned over.
It is different when excess lower eyelid skin must be cut away along with it. In this case, the skin below the eyelashes is incised. This case is explained in Lower Blepharoplasty information.
Recovery is about 1 week as a standard. Swelling and redness of the white of the eye are worst in the first few days. They subside considerably from around 1 week.
If you have work or an appointment coming up, start with the timeline below.
| Time point | Status |
|---|---|
| Days 1–3 | There is swelling and the white of the eye is red |
| About 1 week | Swelling decreases considerably |
| About 2 weeks | This is around when you resume daily activities |
| 1–3 months | The shape settles |
| Activity | Time point |
|---|---|
| Stitch removal | None when the approach is from inside the eyelid |
| Makeup | After about 2 weeks |
| Returning to work, washing your face, contact lenses | Explained at the consultation |
The speed of recovery differs from person to person. If you have an important event coming up, please tell us in advance at the consultation.
Not every dark under-eye is dark circles. A surgery that repositions the bulging fat that causes it.
— Dr. Park Jung Keun, Plastic Surgery Specialist · Face Plus Talk
Without our noticing, we come to feel that our under-eyes have become puffy. Some say the under-eye bulges, while others say, conversely, that it looks hollow. Others say the dark circles are severe. When you try to correct such an appearance you dislike, some places tell you to fill the hollow area with filler, and others tell you to remove the under-eye fat.
The surgery itself is simple, but it is a method that can help change a tired-looking impression into a brighter one. For young people whose skin does not sag much, the outer skin is not incised, so no visible incision mark remains. For this reason, men who worry that the surgery will show also consider it more comfortably.
However, even among young people, the skin may sag considerably. In this case, a better result can be obtained by removing the sagging skin through a skin incision as well.
The specific method is decided according to each person's condition, that is, whether the fat is excessive, whether the under-eye skin sagging is excessive, whether the under-eye groove is deeply indented, and so on. Although it is a relatively simple surgery, lower eyelid fat repositioning is a representative surgery that has a large effect on improving the impression afterward and can give a more youthful-looking face. If you are increasingly told that you look older or tired, it may be worth considering lower eyelid fat repositioning.
In some cases it is not clearly distinguished whether to work on the under-eye fat alone or also reduce the skin. The specific surgical method must be decided through a thorough examination and discussion. Through under-eye surgery, the dark-circle look can improve and the overall impression can look brighter. Of course, it is generally a procedure in which other people hardly notice yet a large improvement in impression can be obtained.
It is done under local anesthesia or sedation.
Surgery takes about 1 hour.
Which anesthesia to use is decided together at the consultation. Please feel free to tell us any concerns then.
Whether local anesthesia is the default or sedation is used in addition, and the criteria for choosing:
Whether fasting is required before surgery, and for how long:
We begin with the most urgent. Blood collecting behind the eye can threaten vision and is an emergency. In addition, swelling and bruising, left-right differences, swelling and bleeding of the white of the eye, double vision, hollowing or residual bulging, and infection can occur.
If something feels wrong after surgery, do not put up with it on your own.
The three below are emergencies. Regardless of clinic hours, call 119 or go to the nearest emergency room.
Bleeding behind the eye is reported to occur most often on the day of surgery[8]. This is especially so within the first few hours. Some cases occurred several days later.
The following are also changes you should report without waiting until your next visit.
Some things are not urgent, but please be sure to mention them at your next visit.
Revision surgery is decided at least 6 months after the first surgery.
We fully understand being bothered by a left-right difference or a remaining bulge. Even so, we first observe how things progress. Revision of eye surgery is explained in detail in Revision Eye Surgery information.
How long the effect lasts differs from person to person. We do not promise a duration in numbers.
Time keeps passing after surgery, and aging continues. As time passes, the shape of the area under the eye can change again.
Yes. There are three typical cases.
Criteria based on your health condition are confirmed at the consultation. This surgery is not right for every under-eye.
In plain terms
Please tell us at your consultation about the medications you take and the conditions you have. Please also tell us about any previous eye surgery. Even things that seem minor are fine.
About 1 hour. It is done under local anesthesia or sedation. Hospitalization is not required. Recovery is about 1 week as a standard.
The shadow caused by bulging fat and the hollow beneath it is what this surgery addresses. Darkness from dark skin color or visible blood vessels is not changed by this surgery. At the consultation, we first sort out the cause.
If excess skin remains due to stretching, lower blepharoplasty is considered. Lower eyelid fat repositioning changes the position of the fat, so the excess skin remains as it is.
Revision surgery is decided at least 6 months after the first surgery.
This links to a video on the Face Plus Plastic Surgery YouTube channel. View All FacePlus TV
These are surgeries and procedures often discussed together with this surgery during consultations. Whether to have them together is decided after an examination.
He personally consults on and performs facial aging treatments such as facelift, droopy eyelid surgery, and thread lift. The doctor personally sees you from consultation through recovery.
About the DoctorThe content of this page is general medical information provided in accordance with the Medical Service Act, and the effects and recovery time of surgeries and procedures may vary by individual. All surgeries and procedures can cause side effects, so please make your decision only after a thorough consultation with a plastic surgery specialist.
Facelift, droopy eyelid surgery, and thread lift: Dr. Park Jung Keun personally checks every stage, from consultation to recovery. Please schedule by phone or KakaoTalk, or leave a consultation request form.
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