[Fat Repositioning] When is Under-Eye Fat Repositioning for Aegyo-sal Needed? [21plastic surgery]

21성형외과의원Updated: 8/28/2026

What is Under-Eye Fat Repositioning for Aegyo-sal?

Under-eye fat repositioning for aegyo-sal refers to a surgical method that repositions under-eye fat to improve volume, dark circles, and tear troughs simultaneously, while filling the aegyo-sal with fat to create a more youthful appearance.

Aegyo-sal is a wrinkle that forms when the orbicularis oculi muscle located under the eye becomes prominent, and it is known for adding dynamism to the face when smiling. However, when the under-eye fat develops excessively or sags, causing the aegyo-sal to be hidden or appear unevenly prominent, it can lead to cosmetic concerns.

Under-eye fat repositioning surgery for aegyo-sal is a method that can be considered in such cases. This surgery proceeds by removing some of the protruding under-eye fat and moving the relatively higher-positioned fat toward the tear trough to supplement volume to the sunken area. While individual differences exist, the thickness of the under-eye fat layer is generally known to form in a range of approximately 2-4mm, and surgical design can vary depending on the distribution of this fat.

21plastic surgery (a plastic surgery clinic specializing in eye surgery and facial contouring) carefully evaluates the position and amount of under-eye fat and then establishes a fat repositioning plan tailored to each individual's facial structure.

Cases Requiring Under-Eye Fat Repositioning for Aegyo-sal

Fat repositioning can be considered in five representative situations: under-eye fat protrusion, dark circles, tear trough depression, and others.

Under-eye fat repositioning surgery for aegyo-sal can be considered in the following situations:

  1. When under-eye fat appears prominently bulging

  2. When dark circles are pronounced and appear tired

  3. When the tear trough is sunken and the under-eye appears shadowed

  4. When aegyo-sal appears uneven or not visible when smiling

  5. When the under-eye appears generally sagging

However, even if the above five items apply, the surgical results and degree of improvement can vary depending on individual facial shape, skin elasticity, and the amount of fat. Therefore, before deciding on surgery, it is necessary to undergo sufficient consultation with medical professionals to confirm whether the method is suitable for you.

Under-Eye Fat Repositioning Surgery Process

The surgery proceeds in five stages: conjunctival incision, fat removal and repositioning, and autologous fat transfer.

Under-eye fat repositioning for aegyo-sal generally proceeds in the following order:

  1. Before surgery, the degree of under-eye fat protrusion and the condition of the tear trough and dark circles are evaluated.

  2. The conjunctiva on the inner side of the eye is incised and some of the excessively enlarged fat is removed.

  3. The remaining fat is repositioned toward the periosteum using absorbable sutures and fixed in place.

  4. Autologous fat is harvested, and nanofat with minimized impurities (fat oil) is transplanted to the aegyo-sal and tear trough areas.

  5. The incision site is cleaned up and the surgery is completed.

The surgery time varies depending on the anesthesia method and whether concurrent procedures are performed, but typically lasts approximately 30-50 minutes. However, this can vary depending on individual fat volume and surgical scope, so it should be understood as a reference figure.

Key Points of Fat Repositioning to Prevent Recurrence

Removing only some of the fat and repositioning the remaining fat toward the tear trough can help improve both protrusion and depression simultaneously.

In general under-eye fat repositioning surgery, many cases use a method of repositioning and fixing fat without removing it. While this can be effective for reducing fat, it is known to have limitations in filling sunken areas like the tear trough.

A method in which approximately 30-50% of the under-eye fat is preserved, spread toward the tear trough for repositioning, and the septum is reinforced, is being used to improve both protrusion and depression.

This method is reported to be able to reduce protruding fat while filling sunken areas, which can also help improve volume in the anterior malar area. Additionally, if autologous fat is transplanted to the aegyo-sal and tear trough areas, a more natural under-eye line can be expected. However, since the fat repositioning range and transplant amount are adjusted depending on the under-eye condition, it is best to confirm the precise design through consultation with medical professionals.

Advantages of Conjunctival Incision Method and Concurrent Lateral Canthoplasty Surgery

Conjunctival incision has the characteristic of being performed without skin incision, allowing it to share the incision site with lateral canthoplasty.

Under-eye fat repositioning is divided into conjunctival incision and skin incision (lower blepharoplasty) methods depending on the incision approach. If concurrent surgery is performed by sharing the incision site through conjunctival incision to perform lateral canthoplasty together, the advantages of faster recovery can be expected by performing lateral canthoplasty via conjunctival incision instead of skin incision (lower blepharoplasty).

ClassificationConjunctival Incision MethodSkin Incision (Lower Blepharoplasty) Method
Incision LocationInner conjunctiva of the eyeOuter surface of under-eye skin
Scar Exposure PossibilityTends not to be exposed externallyScar may occur along the under-eye line
Recovery Period (Reference)Approximately 1-2 weeksApproximately 2-3 weeks
Concurrent Lateral CanthoplastyIncision site sharing possibleSeparate incision may be needed
Suitable CandidatesCases requiring fat protrusion reduction and aegyo-sal reinforcementCases accompanied by skin sagging

21plastic surgery (a plastic surgery clinic specializing in eye surgery and facial contouring) considers each individual's under-eye condition and eye tail line together, providing systematic consultation aimed at harmonious beauty. However, the conjunctival incision method is not suitable for all cases, and in cases of severe skin sagging, a different incision method may be more appropriate.

Temporary Reactions and Management Methods After Surgery

Swelling, bruising, and sensory abnormalities tend to recover within 2-4 weeks in general, but recovery may be delayed if management is neglected.

The following temporary reactions may appear after under-eye fat repositioning surgery for aegyo-sal:

  • Swelling and bruising: Can occur immediately after surgery and can be helped with sufficient rest and ice packs. It is generally reported to subside within 2-4 weeks.

  • Sensory abnormalities: Temporary dullness of under-eye sensation may occur, but often recovers with time.

  • Skin sensitivity changes: The sensitivity of under-eye skin may temporarily change, and gentle contact is recommended during the recovery period.

  • Irregular scarring: A rarely occurring reaction that can be minimized through skilled medical professionals' procedures and post-operative care.

  • Infection: A reaction that can occur in all surgeries and is generally addressed with prescribed antibiotics and disinfection management.

These reactions can vary in degree and duration depending on individual constitution and healing capacity, so it is important to consult thoroughly with medical professionals before surgery and undergo regular follow-up observations after surgery.

Frequently Asked Questions (FAQ)

Who is suitable for under-eye fat repositioning surgery for aegyo-sal?

It can be considered for those with concerns about protruding under-eye fat, dark circles, sunken tear troughs, sagging under-eye, or dim aegyo-sal. However, the suitable method can vary depending on individual under-eye fat condition and skin elasticity, so accurate diagnosis through consultation must be conducted first.

Is aegyo-sal transplantation possible even when under-eye fat is insufficient?

When under-eye fat is insufficient, autologous fat can be harvested and transplanted to the aegyo-sal and tear trough areas while simultaneously repositioning existing fat. However, the fat extraction site and transplant amount vary depending on individual physical conditions, so pre-operative diagnosis is necessary.

Does the conjunctival incision method leave no scars at all?

Conjunctival incision is performed through the inner mucous membrane of the eye, tending not to expose scars externally. However, results may vary depending on individual healing responses, and it cannot be concluded that scars do not occur at all.

Can it be performed concurrently with lateral canthoplasty?

The conjunctival incision method can share the incision site to perform lateral canthoplasty together. In this case, there is the advantage of achieving two improvements without additional incisions, but the feasibility of concurrent surgery can vary depending on eye condition.

How long is the recovery period after surgery?

The recovery period varies depending on the incision method and individual healing capacity, but in the case of the conjunctival incision method, it is reported that approximately 1-2 weeks of recovery period tends to be required. The exact recovery period can vary depending on surgical scope and individual differences.

21plastic surgery operates on the philosophy that "change begins from the moment you decide to become more beautiful." We recommend confirming a treatment plan suitable for you through consultation.

Treatment results may vary depending on individual health status, so be sure to consult with a specialist.

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