Reverse Hamra vs. 'Defatting + Fat Transfer': Which to choose? The answer depends on the volume of under-eye fat and hollowness

When under-eye fullness and hollowness are both present, both the reverse Hamra technique and defatting combined with fat transfer have been reported as methods that address both concerns together[1][2]. There are no direct comparative studies yet, so it cannot be said that one is superior[2]. The guide for choosing depends on three factors: the volume of under-eye fat, the depth of hollowness, and skin laxity[3][4].

Why is defatting alone sometimes insufficient?

Removing fat from the fullness alone does not fill the hollowness beneath it. Removing fat alone is reported to leave hollowness and Under-eye dark circles even when the fullness becomes less noticeable[2].

It is said that it can sometimes make the under-eye depression more noticeable[1]. For this reason, methods that preserve, transfer, or add fat rather than removing too much have become the mainstream approach[2].

How do the two methods differ in mechanism?

The reverse Hamra technique removes the fullness fat without detaching it, and transfers it while still connected to the hollowness below, then secures it[1][5]. Since the procedure is performed from the inside of the eyelid, no scar remains on the skin surface[1].

Defatting + fat transfer is a method in which fullness fat is removed from inside the eyelid, the fat is refined into fine particles, and then injected into the hollowness from above the skin[2]. How much of the injected fat persists has not yet been measured in the research[2].

What did the research show about improvement?

The reverse Hamra technique was reported to eliminate hollowness in 86.7% of participants in a study of 226 people[5]. In a study examining 11 people with MRI, the transferred fat remained below the hollowness, and the thickness of the hollowness region increased by an average of 1.2 mm[6].

Defatting + fat transfer showed 96.6% satisfaction in a study of 183 people[2]. However, since the two studies used different measurement methods, the numbers cannot be compared to say which is superior[2].

How do potential complications differ?

In the fat transfer method, fine wrinkles increased in 5.5% of people, hollowness was not completely filled in 2.7%, and fullness returned in 1.6%[2]. Depending on the injection technique, the surface can become uneven, and the surgeon's skill is critical[7].

Even with the reverse Hamra technique, people with abundant fat can have excessive buildup over the cheek if too much is transferred[3]. In a study of 97 people, some of the fat was refined before transfer to prevent excessive buildup[3].

In the same study, all participants experienced swelling, which subsided within 8 weeks, and cheek numbness resolved within 3 weeks in 3.1%[3]. The extent of bruising also varies depending on how the transferred fat is secured; in a study of 127 people using medical-grade adhesive instead of sutures, severe bruising was reduced[8].

What determines which approach is suitable for you?

Learning what type your under-eye is makes comparison easier.

High volume of fullness fat: transferring alone can cause excessive buildup, requiring refinement techniques[3]

Prominent hollowness and Under-eye dark circles: fat removal alone tends to leave them; transfer or augmentation methods are candidates[1][2]

Strong skin laxity: surgery from inside cannot remove excess skin or fine wrinkles; surgery from the skin side is a candidate[4][9]

What should be confirmed during examination to find the right method for you?

First, having the fat volume, depth of hollowness, and skin laxity actually examined is the starting point[3][4]. These three factors are difficult to assess from photos or a mirror alone.

Then, confirm with your doctor whether fat will be transferred or injected, how the transferred fat will be secured, and how long swelling and bruising may persist.