Why You Should Not Automatically Remove Under-Eye Fat Just Because It Is Bulging

 

hello. Director Park Su-jeong of Gangseo Human Dermatology no see.
Some people ask, “Will it improve if I remove the fat?” when their under-eye area becomes puffy.

 

but You cannot determine the treatment method based solely on how much fat has protruded. This is because it affects the tissue supporting the fat, the depth of the tear trough, and the degree to which the front of the cheek appears bulging.

 

Even with the same 'under-eye puffiness,' some individuals have a significant amount of fat actually protruding, while others have a condition where the surrounding area is sunken relative to the fat volume, making the puffiness appear relatively prominent. The approach to correction differs for these two cases.

 

Therefore, in counseling, rather than “how much can be lost” “What makes it look bulging” We check this first. This is because if the cause changes, the amount and direction of adjustment will differ even for the same surgery.

 

In this article Changes that can occur when a large amount of fat is removed and Things to check before surgery I will tell you.

 

① How do you identify the causes of puffiness under the eyes?

If the tissue supporting the under-eye fat loosens, the fat may be pushed forward. However, Even if there isn't much fat, if the tear trough or cheeks are sunken, the fat above them appears to protrude more. There are also cases where the skin sags or the orbicularis oculi muscle weakens, making the eyes appear puffy.

 

Even if they look similar Those with only prominent inner fat class Those with protrusions extending to the central and outer regions The scope of correction varies. During the examination, the actual location of protruding fat, sunken areas, and skin sagging are distinguished to determine what to correct first.

 

💗 Elements that make it look bulging
✔ Cases where the tissue supporting the fat has loosened, causing the fat to be pushed forward
✔ Cases where the tear trough or cheeks are sunken, causing the fat above to be relatively prominent
✔ When the skin is sagging
✔ When the orbicularis oculi muscle is weakened

 

② What changes occur if a large amount of under-eye fat is removed?

If you remove a lot of fat, the bulge may initially appear to have decreased. However, The fat around the eyes is originally necessary tissue. Therefore, if removed excessively, the area under the eyes may become sunken or the tear trough and bone contours may become prominent.

 

Furthermore, as time passes, if the volume of the surrounding tissue also decreases The flickering may be more noticeable. This means that even if you look fine immediately after surgery, your impression may change a few years later.

 

Therefore, areas with significant protrusion are adjusted as needed, and available fat is evenly transferred to the sunken tear trough area to ensure a natural connection between the under-eye area and the front of the cheeks. We plan by taking into account even the amount of fat to be left behind.

 

⚠️ What can happen if 'losing a lot' becomes the goal
· The area under the eyes looks sunken
· The outlines of the tear trough and bone become more prominent
· The fading becomes more noticeable over time
More than the amount removed Amount to leave and location to move to It is important to decide on that first.

 

③ How is it corrected if the amount of fat in both eyes is different?

The face is not naturally perfectly symmetrical. Fat may protrude more on one eye, while the tear trough may be deeper on the opposite side. In this state If you adjust the fat on both sides by the same amount or move it to the same location The existing differences may remain or even become more noticeable.

 

Before the surgery, in addition to the view from the front Changes when smiling or moving the eyes We also check this, as the impression under the eyes changes depending on facial expressions. After examining the line connecting the cheekbones and the front of the cheeks, we determine the amount of fat to adjust from both sides and the location to relocate it. Each It is important to decide.

 

This is also the reason why I explain the difference between the two sides from the beginning. It is difficult to make the original left-right difference completely identical through surgery, and the goal is not 'symmetry' A state where the difference is less noticeable It is close. If you share in advance which side is more protruding and which side is more sunken, the standard becomes clear when viewing the results after surgery.

 

④ When should treatments other than fat redistribution be considered?

Even if fat protrusion decreases Sagging skin and deep fine lines do not disappear on their own. If dark circles are primarily caused by pigmentation or visible blood vessels rather than shadows created by fat, the changes will be limited. If the volume of the cheeks has significantly decreased, it may be difficult to sufficiently fill the area below the eyes using only under-eye fat.

 

At this time First, explain what problems are most likely to remain. We also assess whether there is a need to separately supplement skin elasticity or the volume of the cheeks. Rather than blindly adding multiple procedures... It is reasonable to address the biggest cause first.

 

If you distinguish in advance between the parts that can be changed by surgery and those that are difficult to change, it becomes easier to differentiate between whether the surgery went wrong and whether the problem persisted due to a different underlying cause when reviewing the results. This is why the process of meeting expectations during the consultation is just as important as the treatment plan.

 

💄 Things good to check together during the consultation
✔ Actual location of protruding fat (inner, center, outer)
✔ The degree of hollowness in the tear trough and cheeks
✔ Skin sagging and depth of fine lines
✔ Whether the cause of dark circles is shadowing or pigmentation/blood vessels showing
✔ Differences between both eyes and changes based on facial expressions

 

 

💬 Frequently Asked Questions

Q1. If the area under the eyes is bulging, is it necessary to remove the fat?

A1. That is not the case. In addition to fat protrusion, tear troughs, hollowing of the cheeks, and sagging skin can accentuate the bulge. We determine the method after identifying the cause.

 

Q2. Do you correct the under-eyes on both sides equally?

A2. Since the amount of fat and tear trough depth may differ on both sides, the correction range is determined according to each individual's condition.

 

Q3. Does fat redistribution also get rid of dark circles?

A3. Shadows caused by protrusions can be alleviated, but if the cause is pigmentation or visible blood vessels, a separate evaluation is required.

 

Q4. If I leave less fat, will I not have to worry about it bulging out again?

A4. Removing too much is not a safe choice. Since the fat around the eyes is naturally necessary tissue, excessive removal can cause the area under the eyes to sink and make the tear trough and bone contours more prominent. For areas with significant protrusion, we adjust the amount as needed and plan the amount to be retained accordingly.

 

Q5. Can sagging skin under the eyes be improved with fat redistribution alone?

A5. Even if fat protrusions are reduced, sagging skin and deep fine wrinkles will not disappear on their own. We determine the scope of treatment after confirming during the consultation whether skin elasticity needs to be supplemented separately.

 

✨ Conclusion

If you remove a lot of fat just because the area under your eyes looks puffy Existing tear troughs or sunken cheeks may become more pronounced.

 

Before surgery, it is necessary to distinguish the actual location of the protruding fat, skin sagging, and left-right asymmetry. Necessary tissue is preserved, and the amount and location of the fat to be corrected are determined according to the condition of each eye.

 

Please determine the scope of treatment after also checking for skin and pigmentation issues that are difficult to address with fat redistribution alone.

 

📖 Reference Materials
· Memon SF, et al. Lower Eyelid Surgical Anatomy. J Craniofac Surg. 2025;36:709-716. (PMID 39585706)
· Drolet BC, Sullivan PK. Evidence-based medicine: Blepharoplasty. Plast Reconstr Surg. 2014;133:1195-1205. (PMID 24776550)
· Liao SL, Wei YH. Fat repositioning via supraperiosteal dissection. Graefes Arch Clin Exp Ophthalmol. 2011;249:1735-1741. (PMID 21853230)
· Yoo DB, Peng GL, Massry GG. Transconjunctival lower blepharoplasty with fat repositioning. JAMA Facial Plast Surg. 2013. (PMID 23471339)

 

 

Gangseo Human Dermatology Clinic

Director Park Su-jeong

- Dermatologist
- Regular member of the Korean Dermatological Association
- Regular member of the Korean Laser Society
- Regular member of the Korean Society of Dermatologic Surgery
- Member of the American Academy of Dermatology (AAD)
- (Former) Head of Dermatology Department, Seoul Military Manpower Administration Physical Examination Center
- Performed over 2,000 lower eyelid fat repositioning procedures