What could be the reason for the eyes looking sunken even after under-eye fat repositioning?

 

hello. Director Park Su-jeong of Gangseo Human Dermatology no see.
There are some people who say that although the bulging has decreased after lower eyelid fat repositioning, "the area under my eyes still looks sunken."

 

However, the sunken appearance after surgery Not all of the hollows are newly formed from surgery. In some cases, the tear trough, which was originally deep, becomes visible, and in others, the volume of the cheeks or the recovery process may have an effect.

 

Different causes require different responses. Making immediate decisions without distinguishing between cases where waiting is necessary and those requiring review can lead to results different from expectations.

 

In this article How to distinguish which areas look sunken and why I will tell you.

 

💗 Four Cases Where the Face Looks Sunken After Surgery
✔ Cases where the original tear trough becomes visible as the bulging decreases
✔ Cases where volume is lacking due to excessive fat removal
✔ Cases where the volume of the front of the cheeks decreases, making the area below them appear sunken
✔ Cases where it temporarily appears different due to differences in the speed at which swelling subsides during recovery

 

① Can the original tear trough become more visible after surgery?

That is possible. The tear trough is a groove that runs from the side of the nose to below the eye, Depending on the shape of the skeleton and the location where the ligaments attach, it may originally appear deep.

 

Before surgery, protruding fat partially obscures the boundary, but as the bulge subsides, the existing groove may become more distinct. This reveals structures that were not visible while the fat was covering the groove.

 

In this case Whether it is a newly formed sinkhole or an existing structure that has been exposed It is necessary to distinguish between them. This is why we compare the pre-operative photos with the current appearance and identify the location of the sunken area.

 

② What kind of hollowing occurs if fat is removed excessively?

If you remove too much fat under the eyes, the volume under the eyes becomes insufficient, and The tear trough or bone contours may become prominent. As time passes and the skin and surrounding tissues thin, the sunken feeling may become more pronounced.

 

Therefore, surgery does not focus solely on completely eliminating the bulge. While preserving necessary fat... So that the boundary between the protruding and recessed areas is smoothly connected Adjusts.

 

If there is already a lack of fat, you must determine the supplementation method after checking the remaining tissue volume. This is because the options vary depending on the degree and location of the deficiency.

 

⚠️ Characteristics of hollowness caused by fat deficiency
· The entire area under the eyes looks flat and sunken
· The outlines of the tear trough and bone are clearly visible
· The sagging becomes more noticeable over time
In this case, first check the remaining amount of fat, and then determine the method of replenishment.

 

③ Do the areas under your eyes look sunken even if your cheeks are hollow?

The under-eyes and cheeks It appears to be connected by a single line. If the volume of the cheeks has significantly decreased, even if the under-eye fat is properly relocated, the area below may continue to appear sunken.

 

The area that can be filled with fat redistribution is the area around the lower eyes. Below that... Lack of volume in the front of the cheeks is a separate issue. Therefore, you must distinguish between the two.

 

If necessary, you can consider adding volume in stages. However, since even small changes are noticeable around the eyes, rather than filling in a large amount at once... We plan carefully, taking into account skin thickness and blood vessel condition.

 

④ How is a temporary shutdown during recovery determined?

Immediately after surgery The rate at which swelling subsides may differ on both sides. The contours may also appear different while the tissue settles. It is difficult to determine the final result or the need for revision surgery based on a single initial photo.

 

If deep depressions, hard adhesions, or distinct asymmetry persist even after sufficient recovery has taken place, a re-evaluation is performed. The location of remaining fat and adhesions, as well as the condition of the skin and anterior cheeks, must be checked. Whether to wait or consider additional treatment You can decide.

 

If you notice any concerning changes during the recovery process, it is recommended to review them together with your doctor during a consultation using progress photos rather than trying to judge on your own. We can explain which changes fall within the normal range at each stage.

 

💄 Things to check when distinguishing the cause of the shutdown
✔ Comparison of pre-surgery photos and current appearance
✔ Exact location of the sunken area (whether it is the tear trough, the entire area under the eye, or the front of the cheek)
✔ Remaining fat amount and presence of adhesions
✔ Volume and skin thickness of the front of the cheeks
✔ Post-operative recovery period and recovery speed on the left and right sides

 

 

💬 Frequently Asked Questions

Q1. If the area under the eyes looks sunken after surgery, does that mean a lot of fat was removed?

A1. That is not the case. There are instances where pre-existing tear troughs or cheek hollowing have become visible. The cause can only be identified by comparing the pre-operative photos with the current structure.

 

Q2. Do I need to wait even if the left and right sides look different at first?

A2. The speed at which swelling subsides may vary. However, if the changes are severe or you have any concerning symptoms, please consult a doctor.

 

Q3. If hollowness remains, do I need revision surgery immediately?

A3. Depending on the remaining fat amount, adhesions, and the condition of the cheeks, you may wait or consider other supplementary methods. A decision regarding revision surgery will be made after identifying the cause.

 

Q4. Can sunken cheeks be resolved with fat redistribution alone?

A4. The area that can be filled with fat redistribution is the area around the under-eyes. For the lack of volume in the cheeks, separate, step-by-step supplementation can be considered.

 

Q5. When is it determined that recovery is complete?

A5. We evaluate after the swelling has sufficiently subsided and the tissues have settled. If deep depressions, adhesions, or asymmetry persist thereafter, we re-evaluate.

 

✨ Conclusion

There is not just one reason why the eyes look sunken after under-eye fat repositioning. A tear trough that was present before the surgery may have become exposed. Lack of fat, reduced volume of the cheeks, or changes during recovery may also have an impact.

 

If you decide to immediately add more fat or undergo revision surgery without identifying the cause, the results may differ from expectations.

 

Please evaluate the pre-operative photos and current condition together to determine the necessary method.

 

📖 Reference Materials
· Memon SF, et al. Lower Eyelid Surgical Anatomy. J Craniofac Surg. 2025. (PMID 39585706)
· Drolet BC, Sullivan PK. Evidence-based medicine: Blepharoplasty. Plast Reconstr Surg. 2014. (PMID 24776550)
· Liao SL, Wei YH. Fat repositioning for tear trough deformity. Graefes Arch Clin Exp Ophthalmol. 2011. (PMID 21853230)
· Yoo DB, Peng GL, Massry GG. Transconjunctival lower blepharoplasty with fat repositioning. JAMA Facial Plast Surg. 2013. (PMID 23471339)
· Xu Z, et al. Complications of Fat Grafting and Repositioning. 2024. (PMID 39158343)

 

 

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