Under-Eye Bags and Hollows in Seoul: Should the Fat Be Removed or Repositioned?

Why do shadows form under the eyes?

Sometimes the mirror shows a puffy area under the eye with a dip right below it. When the top sticks out and the bottom sinks in, the difference in height casts a shadow along the border.

Under-eye changes with age are explained by two things happening together. Fat inside the eye socket (the orbit, the bony hollow that holds the eye) pushes forward, and the cheek tissue moves down. As a result, the bony rim below the eye and the tear trough become more visible.¹

Why a shadow forms under the eye

Replay

1. 1Lid and cheekside section under the eye — when young, lid and cheek blend smoothly
2. 2Fat moves forwardfat inside the orbit pushes forward from behind the septum
3. 3Cheek tissue descendsthe area below empties, creating a step
4. 4Why the groove showsat the tear trough the muscle is attached directly to bone — the groove shows rather than sags, and a shadow falls at the border

Why does that particular spot look sunken?

There is an anatomical reason the tear trough looks hollow so easily. In an anatomical study, the tear trough was where the muscle around the eye (the orbicularis oculi) attaches directly to bone. Further out, the border between lid and cheek was attached to bone by a ligament (a tough band that ties tissue to bone).² Because this area is tied to bone, it does not so much sag; rather, the groove shows more as the skin and fat thin and the fat above bulges.²

Put simply, much of the under-eye shadow is a question of where the fat is rather than how much there is. Fat sticks out above, while there is not enough volume below to support the area. Darkness can also come from skin pigment, so the first step is to tell whether colour or structure is the cause.

When a consultation may help

Under-eye concerns have different common causes, and different things to check, depending on how they look.

What is checked, by how it looks now

• 1A bulge with a hollow below

  Fat often pushes forward over an empty groove; both are measured

  Fat repositioning

• 2Hollow and wrinkles after fat removal

  Volume was lost with the fat; remaining fat and skin are checked

  Revision consultation

• 3Bulging again after surgery

  Remaining fat pushed forward again; the earlier method is checked

  Revision consultation

• 4Lumpy after filler or fat grafting

  Material sits unevenly; what remains is checked first

  Decided after assessment

Hollowing can also get worse over time. A common cause is volume loss and the cheek tissue moving down, so the extent of the hollow and the thickness of the skin are checked.

What does "moving" the fat mean?

Lower eyelid fat repositioning is done through the conjunctiva (the thin moist lining inside the lower lid). The bulging fat is not cut away. Instead, it is moved over the bony rim below the eye and spread into the hollow groove. The idea comes from a principle about deep grooves. When the groove is deep, moving the fat over the rim onto the front of the upper jaw bone works better than removing it.¹

In the cross-section below, the left side is the bulging lid and the right side is the groove.

The path the fat is moved along

Replay

1. 1Through the insideenters through the lining inside the lower lid — no skin incision
2. 2Not removedthe bulging fat stays attached to its blood supply
3. 3Moved to the grooveit is moved over the bony rim and spread into the hollow — the step is reduced
4. 4Fixed at the periosteumBonita Clinic fixes the moved fat to the periosteum below the groove to reduce re-bulging

Where is the moved fat placed?

The moved fat may be placed in a pocket made under the periosteum (the thin membrane covering bone), or spread on top of it. A review of studies comparing the two found that placing it on top of the periosteum is quicker but brings more swelling, bruising and temporary early unevenness. The final results were reported to be similar.³ The review also notes that, depending on how the moved fat is secured, it can push forward again or shift out of place.³

Does the moved fat stay as it is?

The fat is moved with its blood supply still attached, but some of it may shrink over time. In an early report following 24 patients, how much the moved fat shrank differed from person to person. The contour and texture settled after a recovery period of one to two months.¹

Removing, moving or tightening skin: which suits you?

Even with the same "under-eye fat", the right approach depends on how bulging, hollowing and loose skin are mixed.

Removing only vs moving

Replay

1. 1Bulge and hollowthe same under-eye — a bulge above, an empty groove below
2. 2Removing onlythe bulge shrinks but the groove stays, so it can look more sunken
3. 3Movingthe fat is moved into the groove instead, reducing the step

Approaches for different under-eye concerns

Approach	Usually suits	Good to know
Fat removal only	A bulge with little hollowing below	A deep groove can look more sunken
Fat repositioning	A bulge and a hollow groove together	Part of the moved fat may shrink
With skin excision (lower blepharoplasty)	Loose skin and many fine wrinkles	Leaves an incision line on the skin
Filler	Mild hollowing, little bulging	Temporary, so repeat sessions

The review suggests fat repositioning when the groove is deep, the skin is loose, or a longer-lasting result is wanted. When the change is mild or recovery time is hard to find, hyaluronic acid filler can be considered.³ If fat is bulging, however, filler alone has limited effect. Filler is reported to last about six months to two years, so it needs repeating.³

At Bonita Clinic, repositioning is the default, with part of the fat removed as well where needed. If the skin is loose, lower blepharoplasty, which tightens the lower-lid skin, is considered too; this is covered separately on the Lower Blepharoplasty page and in the lower blepharoplasty guide.

An under-eye surface that has become lumpy after filler or fat grafting can also be assessed. The first step is to find where any remaining filler or fat is and what state it is in, and then the method is chosen. If material of unknown content remains, the guide to eye, glabella and nose filler removal may also help.

How does recovery go?

At Bonita Clinic, we perform lower eyelid fat repositioning as surgery under sedation, and you go home the same day. Because the approach is through the conjunctiva without a skin incision, there are no stitches to remove. How long recovery takes, and how often you return for checks, depends on the extent of surgery and on the individual.

What side effects can occur?

A meta-analysis (a study that pools many studies and recalculates the results) looked at 33 studies and 4,671 patients. The overall complication rate after under-eye fat grafting or repositioning was 11.2%. Broken down:⁴

• Under-correction or an uneven contour: 6.2%
• Haematoma (a collection of blood), swelling, bruising or oozing: 6.2%
• Another operation: 2.4%

About 11 in 100 people had some problem, large or small, and 2 to 3 had another operation. The review also reports the white of the eye showing below the iris, the lower lid turning outward (ectropion), and infection. Other reported problems are small granulomas (small lumps from inflammation), reduced lid sensation and dry eye.³

Rare but important: bleeding in the eye socket

In a survey of more than 260,000 cosmetic eyelid operations, bleeding in the eye socket occurred in 0.055% and vision loss that did not recover in 0.0045%. These are rare. However, most cases happened within 24 hours of surgery, especially within 3 hours, and were often linked with high blood pressure, aspirin use, vomiting after surgery or increased activity.⁵

So please:

• Tell us in advance if you take blood pressure medicine or anything that thins the blood.
• Avoid strenuous activity on the day of surgery.
• Contact the clinic immediately if one eye becomes very painful, swollen or hard to see out of.

How we approach it at Bonita Clinic

The order we follow

1. 1Find the causeToo much fat, or fat pushed forward?
2. 2RepositionThrough the conjunctiva, no skin incision
3. 3Fix in placeMoved fat secured to the periosteum
4. 4Follow-upCheck how the moved fat has settled

Treatment options you can discuss in Seoul

Since 1995 Bonita Clinic has been at the same address, and Dr. Kwang-Seop Chung, a plastic surgeon board-certified in Brazil, examines and operates on patients himself. For under-eye bags and hollows, the options discussed in consultation are those on our treatment pages:

• Lower eyelid fat repositioning through the conjunctiva, with fixation of the moved fat to the periosteum
• Partial fat removal combined with repositioning where needed
• Lower blepharoplasty when the skin also sags
• Assessment of unevenness after previous filler or fat grafting, or after earlier under-eye surgery

Which of these you need is decided only after an examination.

Why the plan and cost differ from case to case

Two people with "under-eye bags" can need different operations. How much work is needed, not the name, shapes the plan and the cost.

• Bulging only, or bulging with hollows
• Repositioning alone or with partial removal
• Whether loose skin also needs excision
• Previous surgery, filler or fat grafting
• Anesthesia: sedation

Final plan and quote after seeing you in person

A final estimate is given only after an in-person examination, once the amount of fat, the depth of the groove and the skin have been assessed.

What photos can show, and what needs an in-person exam

Photos are useful for a first look. But some key decisions depend on how the lid behaves when you move your eyes and how the tissue feels.

Photos can show

• Bulges and the shadow line below
• Difference between the two sides
• Fine wrinkles and skin texture
• Uneven areas after filler or fat

Needs an in-person exam

• How far fat bulges when looking up
• Depth of the groove under the bulge
• Lower-lid firmness and skin laxity
• Remaining filler or fat, by touch
• Dry eye or other eye conditions

Helpful photos: looking straight ahead, looking up, and both sides at 45 degrees, without makeup, ideally once with light from above so the shadow shows. If you have had filler, fat grafting or previous under-eye surgery, note roughly when. Send your photos and a note of past treatments by message, and we can look at them first.

Planning your visit and recovery

What is confirmed in advance is the treatment information above: surgery under sedation, same-day discharge and no stitches to remove. How long you should stay in Seoul and when to come back for a check depend on the extent of surgery. Both are decided together with you at consultation.

Bleeding in the eye socket is rare, but it usually starts within the first day. So it helps to keep the first evening calm and stay where you can reach the clinic easily. Swelling and bruising are common early on, and the final contour of the moved fat takes longer to judge. Dated photos of your recovery are useful after you return home. Contact a doctor promptly if redness, pain or swelling increases instead of settling, or if your vision changes.

Real treatment cases

These cases appear on Bonita Clinic's lower eyelid fat repositioning page. Results vary from person to person.

Under-eye bulging with a shadow beneath (front view)

The same case seen from an angle

* Results vary from person to person. Side effects are possible, so please decide after a thorough consultation with a doctor.

Frequently asked questions

Isn't it better to just remove the under-eye fat?

If there is a bulge but almost no hollow below, removal may be suitable. When a hollow is present too, removing fat can make the groove look deeper. So at Bonita Clinic repositioning is the default, with partial removal added depending on your condition.

Will there be a scar?

Because the approach is through the conjunctiva, no incision line shows on the skin. If loose skin is also tightened with lower blepharoplasty, that part leaves an incision line just below the lashes.

Can I have it if my under-eye is lumpy after filler or fat grafting?

Yes, you can be assessed. The method depends on where the remaining filler or fat is and what state it is in, so tell us when, what and how many times you had treatment.

I had fat removed before and now look hollow, or the bulge came back.

Wrinkles and hollowing where fat was removed, or bulging again after surgery, can both be assessed. A revision is a different situation from a first operation. The amount and position of the remaining fat and the earlier technique are checked to see whether there is enough fat to move.

How long is recovery?

How long swelling takes to go down differs from person to person. Bruising and swelling are common early on, and the settled shape of the moved fat can only be judged later. If you have an important event, let us know at consultation.

What to prepare before your consultation

• Your history of under-eye surgery, filler or fat grafting: when, what and how many times
• Medicines you take, especially blood pressure medicine or anything that thins the blood, such as aspirin
• Any dry eye or other eye condition you have been treated for
• Photos looking straight ahead and looking up, plus one with light from above
• Dates of any important events

Bonita Clinic is on the 3rd floor of 565 Gangnam-daero, Seocho-gu, Seoul, about 100 m on foot from Exit 8 of Nonhyeon Station (Line 7). You can read more on our Lower Eyelid Fat Repositioning page. If the skin also sags, see Lower Blepharoplasty and the lower blepharoplasty guide. For upper lids and double eyelids, see Eye Surgery and the guide to double eyelid, canthoplasty and ptosis surgery.