With mask-wearing becoming a part of daily life due to the COVID-19 virus, the eyes have become more important as a body part. Because the eyes are such a prominent feature, the demand for 'eye surgery' among plastic surgeries has recently been on the rise. While there are various procedures available, such as double eyelid surgery, epicanthoplasty, and eye shape correction, there are also many people who suffer from stress due to sunken eyelids.

Why do sunken eyelids occur? Eyelid fat removal surgery is performed when the eyelids are unusually thick or contain a lot of fat. However, there are occasionally people who experience significant fat loss or deep hollowness in their eyelids. This hollowness can occur if the eye socket is naturally deep or if the skin around the eyes is exceptionally thin compared to others. However, the majority of cases are due to aging. The eyelids are areas where fat acts as a filler and is anchored to the dura mater; as the dura mater loosens with aging, the fat can naturally sag. In particular, if the skin around the eyes is thinner than average, the hollowness can be more severe, making the eyes appear sunken.

As we age, volume decreases in various parts of the face—including the temples, cheeks, and eyelids—in addition to the eyes. This can make one look older than their actual age and give the impression of being tired or haggard. Since 'volume' is a key factor in determining a youthful appearance, it is common to undergo eyelid fillers or upper eyelid fat grafting to address sunken or sagging eyelids. Sunken eyelids can be naturally improved through upper eyelid fat grafting.

What is eyelid fat grafting, effective for sagging eyelids? Eyelid fat grafting, also referred to as décolleté fat grafting, involves harvesting the patient's own fat and injecting it into sunken areas. Unlike fillers, which have a short duration and significant side effects, this method has the advantage of lasting semi-permanently for 5 to 10 years or more once the fat has taken root. Eyelid fat grafting can also be effective in correcting multiple eye wrinkles or faded double eyelids, making it a top choice for eye surgery for middle-aged patients and as a cosmetic procedure for parents.

What are the methods and precautions for eyelid fat grafting? Since the eyelids are adjacent to the eyeball and contain a high concentration of nerves and blood vessels, fat grafting is a surgery that requires precise assessment of the condition and delicate technique. Eyelid fat grafting typically takes about an hour and is classified into first and second stages; in most cases, the first stage is sufficient to achieve satisfactory results. However, in cases where the eyelids are severely sunken, a second graft may be decided upon following a one-on-one consultation with the specialist.

For a high survival rate in eyelid fat grafting, high-density fat layers containing stem cells and growth factors must be filtered from the harvested fat and transplanted uniformly and delicately to the precise location. Occasionally, patients may request an excessive amount out of greed, but caution is required as this can actually lead to side effects. Eyelid fat grafting has the advantage of being a convenient option for busy professionals, as the surgery is quick and allows for a rapid return to daily life. However, since sunken eyes can also be caused by the contraction of forehead muscles due to sagging skin or the muscles that open the eyes, in addition to insufficient fat grafting, the correction method must vary depending on the underlying cause.

Eyelid fat grafting restores lost volume around the eyes and improves the overall look to be more vibrant; however, since this is the most visible part of the face, careful consideration is required. Furthermore, because the skin around the eyes is much thinner than other skin, side effects such as unevenness or lumps may occur; therefore, it is recommended to undergo surgery by a board-certified plastic surgeon with extensive clinical experience.

Written by Director Do Eon-rok (Plastic Surgeon)