Lower Blepharoplasty (Under-Eye Surgery)

Who it is for

• Under-eye fat casts a shadow below your eyes
• The area under your eyes is hollow and dark circles stand out
• Under-eye fat makes you look older

What is under-eye fat removal?

With age, the membrane that wraps and holds the under-eye fat weakens. The fat inside is pushed forward and forms a visible bulge under the eyes.

This buildup of fat is part of aging, but stress or poor health can make it stand out. It can appear as early as your 20s.

Under-eye fat removal takes this fat out through the conjunctiva on the inside of the eyelid. Depending on how the fat is spread, some may also be moved and grafted into areas that lack volume.

Because the protruding fat itself is removed, the results tend to last a long time. Dark circles become less noticeable, which can give you a brighter look.

Opening the conjunctiva with a laser

At KOKO Plastic Surgery, we open the conjunctiva on the inside of the eyelid with a laser. The skin surface is not cut, so scars are hard to see and the eye area can look natural.

The laser method causes little bleeding or bruising. Removing some fat through the conjunctiva with a laser is now also done at dermatology clinics.

How under-eye fat removal is done

Surgery follows these steps.

• We locate the fat that bulges most under the eyes.
• A laser opens part of the conjunctiva below the eye to expose the fat.
• The eyelid skin is pressed gently, and the fat that comes out is trimmed away.
• After bleeding is stopped, the opening is closed with 1–2 stitches.

Creating aegyo-sal: hyaluronic acid filler

Aegyo-sal is the soft roll that appears under the eyes when you smile. Without enough fullness there, the face can look flat and older. Aegyo-sal can give a youthful, sweet look and brighten your smile.

Filler (hyaluronic acid) is injected under the skin or subcutaneous fat to smooth hollows or add volume.

An injectable made of the same substance as hyaluronic acid is placed under the eyes to form aegyo-sal. It makes fine lines on the lower eyelid less noticeable and can give a more youthful eye area.

As a rough guide, the effect lasts about a year, so regular treatment is needed.

How it is done: numbing cream is applied under the eyes for about 40 minutes, then hyaluronic acid is injected where the aegyo-sal will be.

Creating aegyo-sal: fat transfer

Excess fat is taken from your thighs, buttocks or abdomen and grafted under the eyes. Because excess fat is removed, the body contour of the donor area is refined at the same time.

• It is done with a combination of local anesthesia and sedation.
• Fat is taken from the thighs, buttocks, abdomen or another area through a thin tube.
• The fat is spun in a centrifuge to remove impurities and separate out the fat cells.
• The fat is injected evenly into several layers under the eyes.

Under-eye wrinkle removal

The skin around the eyes is very thin, so it wrinkles and sags easily. The most important thing when treating wrinkles here is a natural result.

We analyze exactly what is making you look older, then decide on the treatment and surgery. For mild wrinkles, non-surgical options such as Botox or filler (hyaluronic acid) are a good way to improve them for a while.

If aging is more advanced, lower eyelid surgery (lower blepharoplasty) removes the wrinkles. The key is a natural finish that keeps the scar as inconspicuous as possible.

At first there is some redness as the incision heals, but it fades over time and becomes hard to see. Surgery takes about 1 hour, and after the stitches come out on day 5, you can return to daily life.

For details, see our Lower Eyelid Wrinkle Correction page.

Aftercare

Swelling and bruising vary from person to person. To help your recovery, please follow these points.

Under-eye fat removal through the conjunctiva does not cut the skin, so you can wash your face and wear makeup right after surgery.

• Keep the eye area cool from right after surgery until the swelling goes down.
• Avoid sleeping face down or on your side. Raising your head on 2–3 soft pillows or cushions eases swelling and pain.
• Avoid crying a lot, rubbing your eyelids hard or squeezing your eyes shut.
• Avoid alcohol and smoking for 3–4 weeks, as they slow wound healing.
• You can wear contact lenses after 2 weeks. Until then, wear glasses or sunglasses.
• If the skin was incised, light makeup is fine after 2 weeks, and eyelash extensions after about 1 month.
• Avoid baths and saunas for about 3 weeks.