Last updated date: 04-May-2023

Originally Written in English

Middle-age Under Eye Fat Re-positioning


    Lower eyelid anti-aging surgery is performed to brighten dull and aging lower eyelids caused by sagging muscles and a bulging fat layer on the lower eyelid.

    The lower eyelid gets droopy as fat accumulates. The eye bag accumulates, and the other areas become more sunken, giving the appearance of being aged and tired. Lower eyelid fat or under eye bags can be removed or repositioned to the sunken areas on the eyes depending on the individual's physical characteristics and condition.

    Excess skin can be removed in some circumstances. The dark lower eyelids grow brighter and the look becomes younger by relocating the eye bags and fat and filling the sunken regions. 


    What Make Your Eyes Look Older?

    Skin and muscle sagging

       1. Skin and muscle sagging

    The lower eyelids which were previously attached to the bone loosen and gravity causes the eyelids to sag naturally.

       2. Loss of volume.

    The volume of the muscle and the fat under the muscle decreases, making the eyes sunken.

       3. Loss in elasticity.

    Skin elasticity tends to decrease as we age. By checking the elasticity beforehand, canthopexy is performed together to prevent the lower eyelid turning outward (ectropion).

       4. Eye bag protrusion.

    When the strength of the muscle on the eyes decreases, the fat on the lower eyelid protrudes.

       5. Deep tear trough.

    The eyes have a deep crease under the protruded eye bag, which is called the tear trough. The tear trough is where the muscle is attached and it occurs when the tissues around this area become thinner. The tear trough becomes more and more obvious.


    Types of Under-Eye Bags

    Types of Under Eye Bags

    Eye bags can be classified into different types according to the area and shape where it appears:

    • Medial protrusion: The fact under the eyes protrudes inward under the eyes.
    • Outward protrusion: The fat under the eyes protrudes outward under the eyes. 
    • Central protrusion: The fat under the eyes protrudes as a whole.
    • Fat with under eye love band: The fat is combined with under eye love band.
    • Edematous swelling: Swelling under the eyes and around the eyes.
      Although there are many types of under eye bags, the surgical techniques are not considerably different. It is difficult to categorize the numerous patient instances into a few kinds. The skeletal structure and surrounding structures of the eye, the degree of dent of the sulcus lacrimalis, and the thickness of the skin must all be carefully evaluated.

    When it's Recommended?

    Eye bag

    • The eye bag on the lower eyelids stands out
    • Due to dull and dark lower eyelids, the face looks dark and tired.
    • Dark lower eyelids are not covered by makeup.
    • Dark lower eyelids are not brightened by laser treatment.
    • The fat under the eyes (called a love band or an agyosal) becomes flatter and starts to wrinkle.


    Who Shouldn’t Get an Under-eye Fat Re-postioning?

    Under-eye Fat Re-postioning

    You must have enough body fat to undergo liposuction and an under-eye fat transfer. People who are exceedingly thin, engage in strenuous activity, or are pregnant may require dermal fillers instead.

    People who smoke may also be unsuitable candidates. Smoking can have an impact on how effectively your body recovers after liposuction and reacts to fat transfer.


    How Long Does the Under-eye Fat Re-postioning Results Last?

    Under-eye Fat Re-postioning Results

    The results of an under-eye fat transfer might be long-lasting. It might take up to four months to feel the full results. During this time, the transplanted fat produces a new blood supply to help it survive. Because your body absorbs around half of the injected fat, your doctor will inject more fat cells than necessary. If you are dissatisfied with the outcomes, they may recommend another fat transfer therapy. 


    Other Procedures Performed Along with an Under-eye Fat Transfer?

    Based on your aesthetic goals, your healthcare provider may recommend cosmetic face surgery. These procedures can be used in conjunction with or instead of an under-eye fat transfer or dermal filler. These more intensive surgical procedures demand a longer recovery period. These are their names:

    1. Brow lift: A brow lift is often referred to as a forehead lift or brow rejuvenation. It is a cosmetic technique that lifts the soft tissue as well as the skin surrounding the brow and forehead to raise the brows. Additionally, this procedure enhances the overall look of the forehead, brow, and region around the eyes. A brow lift may be beneficial if you have a low, sagging, or uneven brow. A brow lift may also boost your confidence. Usually, the procedure can be performed alone or in conjunction with other facial approaches, including blepharoplasty (eyelid surgery) or a facelift.
    2. Facelift (rhytidectomy): A face-lift is a cosmetic surgical procedure that is designed to make the face look younger. This procedure can be used to decrease sagging skin. It can also help to reduce skin creases around the cheeks and jaws. A rhytidectomy is another term for a facelift. During a face-lift, a flap of skin on either side of the face is pulled back. Extra skin is removed and the tissues beneath the skin are altered. This makes the face look younger. A neck lift is typically performed alongside a facelift. It helps to reduce neck fat and drooping skin. Sun damage, such as fine lines and wrinkles, will not be addressed by a facelift. Other cosmetic procedures can enhance the skin's look or condition.
    3. Eyelid surgery (blepharoplasty): Blepharoplasty is the removal of excess skin from the upper and lower eyelids. With aging, the muscles that support the eyelids expand and weaken. As a result, excess skin and fat may form above and below your eyes. This can cause sagging brows, droopy upper lids, and bags beneath the eyes. Apart from aging, sagging skin around the eyes can decrease peripheral vision, especially in the top and outer parts of the visual field. Blepharoplasty can help to minimize or eliminate certain vision problems. In addition, the technique might make the eyes look younger and more attentive.


    How is Under-eye Fat Repositioning Different to Facial Fillers?

    Facial Fillers

    The fat is added droplet by droplet with under-eye fat repositioning. It is an extremely accurate art that necessitates a high level of skill. Volume is gradually increased until an ideal level is reached, avoiding an "over-filled" appearance and producing a fully natural-looking outcome.

    Furthermore, the substance utilized as a filler - your own body fat - is entirely natural. It acts naturally, with the appropriate texture and movement. Rather than introducing anything foreign or synthetic into your body, it is just a matter of returning fat to regions where it already existed.

    Another significant advantage of using transplanted fat versus cosmetic fillers is that it is a permanent remedy. Unlike fillers, which are absorbed by the body and must be replaced every 9-18 months, transplanted fat is permanent. It only deteriorates as a result of normal aging.


    Before Your Under-eye Fat Repositioning

    Under-eye Fat Repositioning

    Your doctor will discuss your goals and expectations with you during your appointment in order to establish the optimal treatment plan for you. If you have worries about aging, bring in a close-up snapshot of your face from your late teens or twenties (a high school or college graduation photo or a wedding photo works well). This is an excellent resource for your doctor to use in seeing how you've aged and how your face was shaped as a child.

    Every under-eye fat repositioning procedure is adapted to the particular demands of each patient, and your doctor will discuss his recommendations with you. He will also provide you with information on how to prepare for your treatment and what to expect throughout your recovery. You will have plenty of chances to get your questions addressed so that you are comfortable with your decision to undergo this procedure. Being prepared is the first step toward a successful outcome.

    When considering elective surgery, you should always be in good health. Maintain a healthy lifestyle, including diet and exercise, and follow the recommendations of your primary care physician for managing chronic conditions such as high blood pressure and diabetes.

    It is also critical that you do not smoke or use any nicotine-containing products for at least 6 weeks before and after your facelift surgery. Smoking and other kinds of nicotine impair your body's ability to recover normally and can result in significant problems such as fat graft loss and infection. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs: Advil, Motrin, Aleve), and vitamin/homeopathic regimens should be avoided. These can cause more bleeding.


    What Happens During Your Procedure?

    Local anaesthetic

    In most circumstances, your doctor will do this operation in her office while you are sedated and under local anaesthetic. If you are having other procedures performed at the same time, such as a facelift, a qualified surgical center may use deeper sedation or general anesthesia.

    During the procedure, fat is extracted from one part of your body, purified, and then carefully re-injected with specially developed needles into the areas that require contouring. This is often a three-step process that consists of (1) harvesting, (2) purification, and (3) placement.

        1. Harvesting

    Your doctor will suggest a fat removal place and numb it with a local anesthetic injection. He will next make a tiny skin incision and introduce a sterile cannula linked to a syringe to carefully collect fat. Several syringes of fat are typically derived.

        2. Purification

    The fat grafts will be concentrated and purified by gently centrifuging (spinning) the syringes and emptying any fluid or oil. The fat is then put into small needles, allowing for extremely precise application.

        3. Placement

    The recipient site will be established. Your plastic surgeon will numb the area where the grafts will be implanted. He will enter the specialized cannula with a small needle stick and carefully implant the microfat grafts over many passes and into different layers of tissue. A line of fatty tissue packages is carefully implanted in these natural tissue planes with each cannula withdrawal. This is done in a three-dimensional, creative process until the necessary correction is made, resulting in a grafted fat structural grid. As a result, the contour is smooth, lovely, and natural-looking.


    After Your Under-eye Fat Repositioning

    After Under-eye Fat Repositioning

    Your plastic surgeon may choose to inject small quantities of botox into certain places to reduce the resorption of freshly transplanted fat. If this is the case, you may see minor changes in muscle function. However, this is just temporary, and your plastic surgeon will not over-inject, resulting in total muscle weakness.

    Expect mild to moderate face edema. It is normal to have moderate discomfort and edema in the liposuctioned region. Pain is effectively managed using over-the-counter and prescription drugs. Following surgery, you will be given compression bandages. These should be worn constantly with the exception of shower breaks for at least two weeks.

    Bruising at the liposuctioned location is common and normally heals within 2-3 weeks. Typically, this procedure does not require a clinic visit for suture removal. You may return to work (desk job) after 3-7 days. This is dependent on your comfort level. You may begin to gradually resume physical activity 2 weeks after surgery.


    Are there Any Complications?

    Risk under-eye fat repositioning

    Cosmetic under-eye fat repositioning is often misinterpreted as a quick, painless, and complication-free treatment. This might be the case with adequate preparation, adequate physician expertise, and acceptable patient selection. Unsatisfactory outcomes and unanticipated complications do, however, occur.

    Hemorrhage and infection are two major consequences that occur infrequently. Manage hypertension and stop taking medications that make you more prone to bleeding to avoid eyelid hematoma and vision loss from retrobulbar hemorrhage. The need for cautious and meticulous hemostasis during surgery cannot be overstated. Thankfully, retro-orbital bleeding and vision loss are uncommon consequences. Visual loss after blepharoplasty has been reported to occur in one out of every 45,000 patients. Following under-eye fat repositioning, retro-orbital bleeding is the most prevalent complication.

    Bleeding in the retro-orbital space can lead to acute compartment syndrome, which necessitates immediate medical attention. The skin stitches are released, the hematoma is emptied, and the incision is re-explored to determine the source of the bleeding if the active hemorrhage is evident. A lateral canthotomy and cantholysis may be conducted if these treatments do not relieve the compartment syndrome. Exophthalmos and vascular congestion can be treated with intravenous mannitol and steroids to lower intraocular pressure. Orbital decompression may be needed in specific conditions to reduce orbital pressure.

    Because of the high vasculature of the upper eyelids, eyelid infections after blepharoplasty are quite uncommon. When they do arise, however, they are treated as soon as possible with the necessary antibiotics. The wound is exposed, evacuated, and cultured with debridement of necrotic tissue before being closed.

    After under-eye fat repositioning, excruciating pain is unlikely. To control postoperative pain, a mild painkiller without aspirin is typically sufficient. If unmanageable pain persists after under-eye fat repositioning, an examination is conducted as soon as possible to determine the source of the pain.

    Excessive skin removal or incisions made in the wrong spots can lead to complications. The production of a band or webbing may occur if the incision is extended above the medial canthal angle. A noticeable scar or folds may develop if the incision is extended beyond the lateral orbital rim. Excess skin removal from the upper lid can lead to lagophthalmos with exposure keratitis, upper lid ectropion, or downward brow traction, aggravating brow ptosis. This problem can be avoided by carefully measuring the density of skin to be removed before surgery. In the early postoperative period, mild lagophthalmos may develop, which can be addressed with lubricant eye drops and ointment.

    Excessive skin resection, a scar of the orbital septum to the skin, excessive levator advancement, or atypical scar contraction can all cause severe lagophthalmos. A second surgery may be needed to remove the septum's adherence to scar tissue or to put a skin graft to restore the upper eyelids' anterior lamellar shortening.

    Blepharoptosis is a rare complication that might develop as a result of an unintentional levator injury during the surgery. If the ptosis lasts longer than 6 months, the levator aponeurosis must be observed and repaired.

    Accidental injury to the superior oblique muscle during the removal of the medial fat pad can lead to extraocular muscular imbalance (diplopia). The superior oblique tendon can be injured by cautery and tissue excision in the medial supraorbital quadrant.

    Excessive fat removal in the upper eyelid causes hollowing of the soft tissue above the eyelid crease or a deep superior sulcus. Another issue that can result in asymmetry or folds in the eyelids, as well as a dissatisfied patient, is residual extra skin or fat. Eyelid crease asymmetry can occur as a result of inadequate preoperative planning or a less-than-pleasant response to the surgeon's attempt to change the crease position. When a patient has previous unilateral ptosis, the asymmetry may become more noticeable after the overlying skin folds are removed.


    Is Under-eye Fat Repositioning Painful?

    IV sedation

    Local anesthetic, oral or IV sedation, or general anesthesia are all options for under-eye fat repositioning. The type of anesthesia utilized is determined by the patient's comfort level, overall health, and the presence of additional surgeries like a brow lift, facelift, or rhinoplasty. A local anesthetic and an adequate sedative can provide patient comfort. Some patients, on the other hand, prefer to be unconscious during their operation. During the meeting, doctors help patients choose what will work best for them by going over the details of each choice.



    When the fat around the eyes is excessively accumulated or sunken, the eyes underneath appear dull and gives a tired impression. In this case, we perform procedures such as under-eye fat repositioning to fill up more fat under the eyes, Under Eye Fat Removal to remove excess fat, and Under Eye Fat Repositioning to even out the fat under the eyes. 

    To ensure excellent surgery results with a high degree of completion, a precise analysis must be made to consider the characteristics of each patient’s eyes and to carry out the specific surgery method.