Under-Eye Fat Repositioning FAQ

Under-eye fat removal takes out the bulging under-eye fat, while under-eye fat repositioning keeps that fat and moves it down to spread into the hollow area below (the tear trough). Removing a lot of fat can make the under-eye area look hollow over time, so repositioning is often considered to address an accompanying tear trough hollow.

After under-eye fat repositioning, many people can return to daily activities within a few days if there are no stitches, or after 1 week if there are stitches. The under-eye compression tape is removed 2 days after surgery; without stitches, washing your face with water is possible from day 3 and with cleanser from day 7. With stitches, face washing is possible after the stitches are removed on day 7. Makeup, except on the surgical area, can be applied after 3 days. Wait 4 weeks before wearing contact lenses, using a sauna, or doing strenuous exercise. Recovery speed varies with the extent of surgery and the individual.

If the area under your eyes bulges, a shadow forms below it, and the shadow fades when you gently pull the under-eye skin, it is likely a fat-type dark circle. People who are often told they look tired even when they are not frequently have the fat type as well. Pigment-type dark circles often keep their brown or bluish color even when the skin is pulled, and we recommend an in-person consultation for an accurate diagnosis.

The cost of under-eye fat repositioning depends on how much the fat bulges, the extent of correction, and whether a fat graft is combined. Even for the same procedure, the scope of surgery can differ depending on your under-eye condition, so an exact cost can be provided after a consultation.

Swelling and bruising after under-eye fat repositioning usually go down noticeably within 1–2 weeks. They are worst on days 2–3 after surgery and gradually decrease after that. Early on, you may have more tearing or eye discharge, or temporarily blurred vision. Cold compresses for 7 days, sleeping with your head elevated for 3–5 days, resting for 2–3 days, and avoiding alcohol and smoking for 4 weeks can help recovery, and results vary by individual.

Yes, under-eye fat repositioning and a fat graft are sometimes done together. If there is little under-eye fat to move, or the hollowing across the tear trough and the front of the cheek covers a wide area, repositioning alone may not provide enough volume, so a fat graft is added. When the orbital fat bulge is sufficient, repositioning alone is often enough, so the decision is made at the consultation based on the amount of fat and the degree of hollowing.

Besides temporary swelling, bruising, and a foreign-body sensation, under-eye fat repositioning can rarely cause asymmetry, fat lumps (nodules), residual hollowness or bulging, ectropion (the lower eyelid turning outward), or diplopia (double vision). The likelihood depends on the under-eye condition and the surgical method, so a thorough consultation before surgery and follow-up checks after surgery are important.

Under-eye fat repositioning is performed with a transconjunctival approach through the inner side of the lower eyelid, so there is no incision on the skin. The conjunctival incision is closed with dissolvable sutures that do not need to be removed; only with the external fixation method are the fixation sutures that exit through the under-eye skin removed at around 7 days. However, if the skin sags enough that it also needs to be addressed, lower blepharoplasty is considered.

Under-eye fat repositioning is usually performed under IV sedation and takes about 1 hour. It may take longer when combined with a fat graft or when the area of correction is wide, and the anesthesia method is decided at the consultation after checking your health and the extent of surgery.

Revision after under-eye fat repositioning is rare, but it may be considered if too little fat was moved and some bulging remains, or if too much was moved and hollowing develops. Revision is usually done after 6 months, once the tissue has stabilized. To reduce these cases, it is important to plan the surgery considering the amount of fat and the hollowing in the front of the cheek.

Whether stitches need to be removed after under-eye fat repositioning depends on how the fat is fixed. Internal fixation secures the moved fat to tissue inside the eyelid, so there are no visible stitches, while external fixation brings the fixing suture out through the skin below the eye and removes it around 7 days after surgery. Internal and external fixation each have pros and cons, and the method is decided at the consultation.

In under-eye fat repositioning, internal fixation secures the fat to the periosteum or the subcutaneous fat layer. It has the advantage of no stitch removal, but in rare cases choosing the fixation point can be difficult or the hold may be weak. External fixation makes it easier to fix the fat firmly in a more precise position, but it requires a visit to remove the stitches, and face washing and makeup must wait longer. With recent advances in instruments designed for internal fixation, the difference is not large, so the method is chosen at the consultation based on each person's situation.

Septal reinforcement in under-eye fat repositioning is a technique that, after the moved fat is fixed, secures the orbital septum in front of the fat once more to support it. Its purpose is to reinforce a loosened septum and reduce recurrence, in which the fat pushes forward again. Whether to add it to repositioning is decided based on how weak the septum is and how much the fat bulges.

The results of under-eye fat repositioning tend to be long-lasting. Because the tear trough ligament is released during surgery and the space is filled with fat, it is uncommon for a deep shadow like the one before surgery to return with age. However, if the skin sags with aging or the amount of fat changes, additional surgery may be needed, and results vary by individual.

Under-eye fat repositioning is possible after lower canthoplasty. However, because both surgeries involve the lower eyelid, part of the lower canthoplasty may loosen depending on how it was originally done. If you have not yet had lower canthoplasty, it can also be done at the same time as under-eye fat repositioning.

Under-eye fat repositioning is performed through the conjunctiva on the inside of the eyelid (transconjunctival) to move bulging under-eye fat into the hollow tear trough, while lower blepharoplasty uses an incision just below the lashes to reposition fat and also remove excess sagging skin. If there is little skin sagging and the main issue is bulging fat, under-eye fat repositioning is often considered; if the skin is loose and wrinkled, lower blepharoplasty is often considered. The choice between the two depends on the degree of skin sagging and elasticity rather than age.

Under-eye fat repositioning can be done even if your under-eye area is hollow, but if there is little under-eye fat or the hollowness is severe, a different procedure may be needed. Depending on the border where the under-eye area meets the front of the cheek, the size of the cheekbones, and the amount of fat in the cheekbone area, we plan fat repositioning, septal reinforcement, a midface lift, or a fat graft. It is best to identify the cause first through a detailed consultation with a board-certified plastic surgeon.

Under-eye filler fills a hollow tear trough with filler to soften the contour, while under-eye fat repositioning moves bulging under-eye fat into the hollow area to correct both the bulge and the hollow. Filler can be considered when there is almost no under-eye fat bulge and only mild hollowing, but if filler is injected while fat is bulging, the border may still be noticeable.

Under-eye bags form when the orbital fat surrounding the eyeball pushes forward and bulges as the orbital septum that holds it back weakens. This often happens as the septum and skin loosen with age, but it can appear even in your 20s if the septum is genetically weak or there is more fat. Because it is not fat from weight gain, it usually does not shrink much with weight loss.

No, under-eye fat is difficult to remove with massage or creams. Because it is a structural problem in which orbital fat pushes through a weakened orbital septum, massage or creams may temporarily reduce puffiness but cannot change the position of the bulging fat. Rubbing the eye area hard can irritate the skin, so care is needed.

No, treatment for dark circles depends on the cause, so not all of them improve with surgery. Fat-type dark circles, where bulging under-eye fat casts a shadow, often improve with under-eye fat repositioning, but for pigment-type dark circles caused by skin pigmentation or vascular-type dark circles where blood vessels show through thin skin, laser or skin treatments are considered. Several causes are often mixed, so the cause is checked first at the consultation.

Rather than new wrinkles forming after under-eye fat repositioning, existing fine lines or reduced skin elasticity can become more noticeable once the bulge is gone. This is because skin that was stretched tight by the bulging fat loosens. If there is significant skin sagging, lower blepharoplasty is considered.

No, under-eye fat repositioning works on fat deeper than the aegyo-sal (the small fullness under the lower lash line, formed by the orbicularis oculi muscle), so it does not remove the aegyo-sal itself. Early after surgery, swelling can make the aegyo-sal look blurred, but after recovery, the border that was hidden by the bulging fat becomes clearer, and the aegyo-sal often looks more defined. If you want more aegyo-sal, aegyo-sal filler can be considered after 1 month, once the swelling has subsided.

Yes, a firm or slightly lumpy feeling under the eyes after under-eye fat repositioning is common during recovery. It is temporary firmness as the moved fat attaches to the surrounding tissue, and it usually softens over 3–6 months. If the symptoms are severe enough to be uncomfortable, or there is pain or redness, it is best to visit the clinic for a check.

Under-eye fat repositioning for men focuses on improving a tired-looking appearance, and the surgical method itself is the same as for women. Men often have thicker skin and more under-eye fat, so the amount of fat is carefully adjusted, and the goal is a natural under-eye line without making the aegyo-sal (the small fullness under the lower lash line) overly prominent.

After under-eye fat repositioning, it is best to avoid alcohol and smoking for at least 4 weeks. Alcohol can make swelling and bruising last longer, and smoking reduces blood circulation, which can slow wound healing and increase the risk of inflammation. Swimming, saunas, and strenuous exercise should also be avoided for 4 weeks, while light walks are fine from the day after surgery.