Non-incisional Dark Circles and Under-Eye Sagging Removal

What are dark circles and sagging under the eyes?

The main causes of dark circles and sagging under the eyes are the "orbital fat" that surrounds the eyeball protruding forward due to aging and relaxation of the orbicularis oculi muscle. This fat protrusion creates shadows, resulting in prominent dark circles and shadow circles. In a review in the Journal of Cutaneous and Aesthetic Surgery (2016), under-eye dark circles are characterized as a multifactorial condition combining orbital fat herniation, subcutaneous fat atrophy, and skin sagging, with "structural shadowing" from fat protrusion positioned as the cause type with the highest treatment effectiveness (doi:10.4103/0974-2077.184046).

Orbital fat under the eyes is divided into three compartments: medial, central, and lateral. When the medial and central fat, in particular, protrudes forward, the gap with the tear trough (lacrimal sulcus) becomes emphasized, leading to a tired and aged appearance. In an explanation in Annals of Dermatology (2018), the shadowing effect from orbital fat protrusion can be fundamentally improved through fat removal or repositioning rather than injectable treatments (doi:10.5021/ad.2018.30.5.522).

How Transconjunctival Fat Removal (Non-incisional Dark Circle Treatment) Works

Transconjunctival Lower Eyelid Blepharoplasty is a technique that removes orbital fat through a very small 2-3mm approach from inside the lower eyelid (conjunctival side). Since the skin is not incised at all, no scars remain externally, and downtime from swelling and bruising can be significantly reduced compared to conventional skin incision methods (transcutaneous approach). A comparative study in Plastic and Reconstructive Surgery (1995) (doi:10.1097/00006534-199510000-00007) reports that the transconjunctival approach provides fat removal effectiveness equivalent to the transcutaneous approach while presenting significantly lower risk of postoperative complications.

A more advanced technique is "Fat Repositioning." By repositioning and securing the extracted orbital fat into the tear trough depression, we can simultaneously correct "hollowing" that tends to remain with fat removal alone. A study on expanded transconjunctival method in Plastic and Reconstructive Surgery (2017) (doi:10.1097/prs.0000000000003561) reports that combining tear trough ligament release with fat repositioning yields more natural and longer-lasting rejuvenation effects. We propose an optimal plan combining simple fat removal or fat repositioning based on your condition.

Procedure Flow and Downtime

Day of Procedure Flow

We perform the procedure while effectively controlling pain through topical anesthesia and local anesthesia (injection). We make a very small 2-3mm incision on the conjunctival side and confirm and remove fat in each compartment. The procedure time is approximately 20-40 minutes for both eyes. Since we use absorbable sutures for closure, suture removal is often unnecessary. After the procedure, we protect with light gauze, and you can return home the same day.

Downtime Guide

Since the transconjunctival approach does not incise skin, swelling and bruising are relatively mild. Peak swelling occurs 1-3 days post-procedure, and most patients can return to daily life and work within one week. If bruising occurs, it is often manageable with concealer and becomes inconspicuous within approximately two weeks. We ask that you refrain from strenuous exercise, alcohol, and saunas for approximately one week after the procedure.

Duration of Effects and Precautions

Once removed, orbital fat generally does not increase again, so the effects are essentially permanent. However, skin sagging and changes in cheekbone structure due to aging continue, so additional care may be necessary in the future. While the procedure is highly effective for dark circles (shadowing from fat protrusion), its improvement is limited for blue circles (vascular transparency) and brown circles (pigmentation) since these have different causes. We will carefully diagnose the cause type during consultation and guide you to the optimal treatment.