Under-Eye Fat Repositioning: Is It Simply a Surgery to Remove Fat?

Hello, this is Dr. Hanjung Lee, Head Representative Director at ATOP Plastic Surgery.

Today, I would like to talk about under-eye fat repositioning.

When the area under the eyes looks noticeably bulging or dark circles appear deep, people often assume that it is simply due to having "too much under-eye fat."

However, the actual appearance under the eyes is shaped not only by the volume of fat, but by a complex interplay of anatomical factors, including the surrounding eye muscles, skin, the position of the fat, eye shape, and the degree of sagging.

Therefore, rather than viewing under-eye fat repositioning as simply excising protruding fat, it is best understood as a procedure that accurately evaluates the current under-eye anatomy and repositions unnecessarily bulging fat to smooth and flatten the under-eye area.

1. Why Does the Under-Eye Area Look Bulging and Sunken?

Aging and bulging under the eyes are not caused merely by an increase in fat volume.

Around the eyes, there are several supporting tissues that encase the orbital fat. Over time, the elasticity of the skin and soft tissues declines, and the structures supporting these tissues can become loose. When this happens, fat can protrude forward, or the tear trough area can appear relatively sunken, contributing to an aged appearance.

Therefore, when planning under-eye fat repositioning, the focus should not merely be on "how much fat to remove," but rather on how to naturally smooth out both the protruding and sunken areas together.

In particular, removing more fat than necessary can lead to a hollowed, sunken look under the eyes. Thus, it is crucial to comprehensively assess each individual's fat volume and under-eye condition.

2. The Core of Under-Eye Fat Repositioning Is 'Repositioning,' Not 'Removal'

Under-eye fat repositioning and under-eye fat removal sound similar, but their surgical objectives differ.

If the fat is simply protruding excessively, removing a portion of the fat can be considered. However, when protrusion and hollowing appear together, relocating the fat rather than removing it unconditionally is often far more appropriate for smoothing out irregular contours.

In other words, the goal is not simply to flatten the under-eye area unconditionally, but to soften the harsh boundaries created by bulging fat and create a seamless, natural transition from the under-eye down to the midface.

Throughout this process, a surgeon must evaluate not only individual differences in fat volume and position, but also skin elasticity, muscular structure, eye contour, and the degree of tissue sagging.

3. Crucial Factors for Natural Eyes: 'Septal Reinforcement' and 'Love Band (Aegyo-sal) Preservation'

Surgery That Accounts for the Orbital Septum

The orbital septum is an essential structure that envelops and supports the compartment where peri-orbital fat resides.

When under-eye fat protrudes, the condition of the orbital septum must also be evaluated. When necessary, a procedure that properly tightens the lax septum can be performed concurrently during surgery.

Rather than simply moving fat, the underlying support structures beneath the eye must be addressed as well. In under-eye fat repositioning, improving the structures enclosing the fat is just as vital as deciding how much fat to address.

Preserving the Love Band (Aegyo-sal) as Naturally as Possible

Another critical element is the preservation of the love band (aegyo-sal).

Located directly beneath the lower lash line, the love band plays a major role in defining the youthful expression of the eyes. Making the under-eye excessively flat or causing unnecessary trauma to surrounding tissues can drastically alter the natural eye shape and impression.

Consequently, in under-eye fat repositioning, it is essential to plan the surgery while considering the shape of the love band and surrounding tissues, including the orbicularis oculi muscle, rather than solely focusing on smoothing out bulging fat.

4. Why You Need an Under-Eye Fat Repositioning Method Customized to You

A single, standardized under-eye fat repositioning technique cannot be applied uniformly to everyone.

Surgical approaches differ widely depending on whether someone has a large or small amount of under-eye fat, firm skin or severe laxity, or prominent under-eye bone structure and deep tear troughs.

In cases with severe skin laxity in particular, desired results may be difficult to achieve with fat repositioning alone. Therefore, the scope of surgery must be determined by thoroughly evaluating both the skin and muscle conditions.

The surgical technique for under-eye fat repositioning also adapts to individual conditions. At ATOP, surgery is performed using a micro-incision through the conjunctiva on the inner side of the eyelid, leaving no external visible scars and minimizing bleeding, swelling, and bruising.

In Conclusion...

The under-eye area is a region where even subtle adjustments can dramatically transform overall facial impressions. Therefore, rather than approaching under-eye fat repositioning as merely excising protruding fat, it is crucial to establish a surgical plan that comprehensively factors in the position and volume of fat, as well as surrounding structures such as the skin, muscle, orbital septum, and love band.

Above all, achieving natural results demands a delicate approach that avoids excessive fat excision, reinforces the septum when necessary, and preserves the love band and surrounding tissues.

Because lower eyelid anatomy and laxity vary from person to person, it is essential to accurately evaluate your own skin condition before deciding on surgery and select the surgical approach that best suits your needs.

I hope this article provided a clear understanding of orbital septal reinforcement and love band preservation during under-eye fat repositioning. I will return with more informative content next time.

Thank you.

Frequently Asked Questions

Is under-eye fat repositioning simply a surgery to remove fat?

No, rather than removing fat unconditionally, it is a surgery that shifts and repositions fat to smooth contours. Excessively excising fat can lead to a hollowed appearance, making it crucial to create a smooth transition between bulging and sunken areas.

What is the primary cause of bulging under the eyes?

It is caused not only by fat volume, but primarily by decreased elasticity in the skin and soft tissues supporting the orbital fat. As these supporting structures loosen, fat bulges forward and tear troughs deepen, creating an aged look.

Why is orbital septal reinforcement important during surgery?

Because the orbital septum is the critical structure that encases and supports the peri-orbital fat. Tightening a weakened, lax septum alongside fat repositioning strengthens the foundational support, ensuring stable and natural results.

Can the love band (aegyo-sal) disappear after under-eye fat repositioning?

Excessive trauma to surrounding tissues can compromise the shape of the love band. Therefore, the surgery must be performed with careful preservation of the orbicularis oculi muscle and adjacent tissues to maintain the natural love band.

Will there be visible external scars after surgery?

No, by using a transconjunctival micro-incision inside the lower eyelid, no external surgical scars are left. This technique also helps minimize bleeding, bruising, and postoperative swelling.