Asian Undereye Hollows

Q: Dr. Eppley,  I am 23 years old. I’ve had undereye hollows or dark circles since I was a senior in high school. To hide them, I have to pack on a lot of concealer and foundation, layer after layer, and I’m tired of doing it!

I’ve tried fillers, but they never last long (maybe 3-6 months.) I think they tend to last a lot shorter of a time because I am young and quite active. It’s taken quite a toll on my wallet and to be honest, I can’t really afford multiple top-ups every year anymore.

I’ve actually consulted some surgeons on doing fat grafting for under the eyes, but most of them have told me the same thing. My undereye skin is thin compared to the skin everywhere else, and that they couldn’t guarantee that there wouldn’t be any lumps and bumps from the fat. 

So, I’ve been looking into undereye surgeries for Asians to correct my type of issue. Where better than Korea, where they specialize in Asian surgeries?

I’ve been looking at lower eye surgeries for young individuals in Korea and came across something called under eye fat repositioning. A fair amount of clinics seem to offer this type of surgery where they somehow relocate unnecessary fat swollen in the lower eye to the more hollowed parts. 

I was wondering what is your insight onto this procedure and would it be beneficial to me in reducing my undereyes?

They say no wrinkles are incised, making it different from a lower bleph, and I’m not really sure what to make of this.

What would be your suggestions to a long-term solution to my problem? I understand that no surgery can stop the ageing process but for me, surely there would be some long-term solution that at least slows down the aging process under my eyes?

A: Thank you for your inquiry. In answer to your undereye hollows treatment questions:

1) Transpostiion of infraorbital fat out to the undereye area is a commonly performed lower blepharoplasty procedure today. However you have to have herniated or protruding infraorbital fat to do so….which you do not. Thus this form of ‘fat grafting’ will not work for you. You will have to bring fat from somewhere else into the lower eyelid to do so.

2) You have touched on the potential issue with injection fat grafting, that of irregularities. It can be an effective treatment if the fat is micronized, where the risk of irregularities is very low, but this also lowers its survival percent.

3) The other fat grafting option for undereye hollows is a dermal-fat graft which is harvested from some other body location and then placed through a lower blepharoplasty incision. This tends to survive better than injection techniques with a lower risk of irregularities but does have a donor harvest site. (scar)

Dr. Barry Eppley

Indianapolis, Indiana