- - Surgery to correct eye bags or so-called dark circles and lift sagging subcutaneous fat and skin due to aging
- - Surgery to rejuvenate the lower eyelid such as dark circle removal surgery
- Dark circles in the eye bags make one look tired and old. With age, the skin of the lower eyelid becomes thinner, the ligaments that support the lower eyelid loosen, and the subcutaneous fat drops, resulting in wrinkles and sagging. When dark circles are added to the appearance, the patient looks even older. There are several different surgical approaches.
Our Clinic's Approach
We use a wide variety of approaches to treat sagging eye bags and dark circles under the eyes.
- Conjunctival incision with additional free fat graft to improve tear trough
- Harmra method with more skin excision
- Lift combines orbicularis oculus, SOOF, deep nasolabial fat, etc.
- Mid facelift can be performed in two ways: subperiosteal or supraperiosteal
Surgical Procedures
Transconjunctival Blepharoplasty
Suitable for patients with little skin and only prominent dark circles. An incision of 1cm is made on the conjunctiva behind the lower eyelid and the excess orbital fat is removed. Since the incision is made on the back of the eyelid, there is no visible scar and no need to remove stitches.
Extended Transconjunctival eye bags removal with the tear trough or Reverse-Hamra method
This is the method proposed by Chin-Ho Wong et al. in Singapore.1) Suitable for patients who have prominent deep nasal (medial) troughs on the lower eyelid in addition to dark circles. As with the liposuction, an incision is made through the conjunctiva behind the eyelid. The deep trough is the ligament that supports the lower eyelid and is called the tear trough ligament. By cutting away this ligament, the valley-like sulcus is improved and the dewaxed orbital fat is placed to fill in the valley. Since the incision is made on the back of the eyelid, there is no visual scar and no need for suture removal.
The reverse-Hamra method involves appropriately reducing the amount of orbital fat protruding from the conjunctival side and repositioning it to cover the valley with a septal valve (septal fat valve, fat valve) that covers it. By successfully using the above two methods, we treat dark circles and hollows without cutting the skin.
1)Wong CH .Advanced Approach to Asian Lower Blepharoplasty . Clin Plast Surg 2023;50 121-130 Codner et al. also reported the same in PRS.
2)Plastic and Reconstructive Surgery June 2017
Hamra Method
Suitable for patients with both sagging eye bags and dark circles. This method involves cutting the skin approximately 2mm below the eyelashes and placing the protruding orbital fat so that it moves into the hollow of the eye. Excess skin, one of the causes of wrinkles and sagging, is also removed. This surgical procedure can greatly improve the rejuvenation of dark circles, wrinkles, and sagging eye bags. Traditionally, the amount of skin excised with the Hamra technique was limited to a few millimeters due to the risk of eyelid ectropion, but by rotating the skin to be excised, 1cm excision is possible. By rotating the skin, the lower eyelid after excision is natural and this method also has the effect of lifting up sagging skin. The rotational skin removal method also allows additional skin removal for patients who have previously undergone surgery using the Hamra method. It is also an effective method for patients who have undergone the Hamra procedure, but would like to have more elasticity.
1)The American Journal of Cosmetic Surgery 2023
Mid Facelift
This method is approached through the same incision lines as the Hamra method procedure. It is often performed at the same time as the dark circles removal surgery. There is also a midface lift from the temple area, which is explained in detail on the page of Facial Sagging Surgery.
There are two approaches: supraperiosteal and subperiosteal. Both methods raise the midface by raising the SOOF (Sub-orbicularis oculi fat), which is connected to the SMAS, the fascia of the face under the orbicularis oculi muscle. In the case of subperiosteal elevation, a hole may be drilled in the bone for fixation. This is a more powerful lift but has the disadvantage of long recovery downtime. Supraperiosteal elevation has the advantage of shorter recovery downtime than subperiosteal elevation and a more natural lift can be expected. As with the Hamra method, a combination of raising the orbicularis oculi muscle and suturing the external angular ligament is performed. Since the soft tissues are lifted firmly, a significant amount of excess skin is expected to be removed.
Postoperative progress and Precautions
To reduce swelling and bleeding, the patient will be asked to place gauze over the lower eyelid and apply pressure with elastic tape before going home. Postoperative swelling can be reduced by sleeping with a high pillow and keeping your head elevated during the day.
If the pain or burning sensation is strong, please cool the affected area gently with an ice-cube over the gauze. We ask patients to visit the doctor for a follow-up examination the next day and the stitches will be removed one week after the surgery.
- Lower Eyelid Ectropion
Ectropion may occur with time. Usually, it improves within 3months. If not, surgery may be required to correct the ectropion. - Conjunctival edema and lacrimation
Swollen or pulled eyelids may cause conjunctival edema or watery eyes when the eyelids come in contact with the eyeball. Steroid eye drops may be used to monitor the progress of the condition, which usually improves within about one month after the surgery. - Asymmetrical
- Recurrence of eye bags (dark circles)
Fat Injection Therapy
Fat injections may be used in conjunction with fat injections to treat sagging under the eyes.
Fat Injection
In addition to the above surgeries, fat injections may be recommended for cases in which the atrophy of subcutaneous fat due to aging is strong and a more firm skin is needed or in cases in which fine wrinkles around the eyes are noticeable or expected to be noticeable with the transconjunctival method.
Microfat Injection
Liposuction is performed mainly from the inner thighs, and the fat is then finely divided to a micro level in a centrifugal separator. The purpose of this procedure is to create firmness in the forehead, temples, and hollows under the eyes.
Nanofat Injection
The micronized fat is further refined into nanofat using a special filter. This treatment is performed to improve fine lines and wrinkles under the eyes.
Cautions for Fat Injection Therapy
Usually about half of the injected fat will settle. Fat that does not settle and is not absorbed may be touched as a lump.
Hyaluronic acid injection
Hyaluronic acid injections are available for patients who are hesitant about surgery or for postoperative adjustments. Compared to fat injections, hyaluronic acid injections are easier to perform. It is absorbed over time, so regular injections are necessary. Patients with thin skin may be at risk for transparency.