Repositioning or removal
What is the difference between moving and removing under-eye fat?
Fat repositioning moves orbital fat into the hollow below an eye bag; fat removal reduces the projecting fat. A transconjunctival approach enters through the inner eyelid, while a skin approach also allows excess skin to be removed.[1][2]
Written by the Korea Under Eye editorial team from the sources listed on each page. Last updated: .
What is making the under-eye area look dark?
An eye bag can cast a shadow over the hollow beneath it. Pigmentation, visible blood vessels and skin changes can also contribute to dark circles. Surgery that changes the contour addresses a different problem from colour within the skin. Identifying the main feature you want changed helps define a useful surgical goal.[4]
In Korea, 눈밑지방재배치 refers to under-eye fat repositioning. Japanese readers may know the inner-eyelid approach as 裏ハムラ and fat removal as 経結膜脱脂. Ask for the incision and the intended tissue changes in writing: a procedure name alone leaves important details unanswered.
Where does repositioned fat go?
Orbital fat sits around the eye, behind a supporting sheet called the orbital septum. When fat projects forward above a hollow at the orbital rim, the transition from eyelid to cheek becomes more pronounced. Repositioning uses this nearby fat to soften that transition.[3][1]
Through a transconjunctival incision, the surgeon mobilises fat while retaining an attachment, then brings it beyond the lower orbital rim. Releasing attachments near the tear trough and arcus marginalis creates room for the transfer. Published techniques place fat above or below the periosteum, the covering of the bone.[1]
The amount available, its reach and the fixation method are part of the surgical plan. Ask the surgeon to match each proposed movement to a visible feature: the projecting bag, the groove underneath it or the broader lid–cheek transition. Different operations can share the same general name.[1][2]
When might fat removal be considered?
Removal can be considered when projecting fat is the main concern and there is little excess skin. A hollow beneath the bag changes the planning question: reducing the projection must be considered alongside the volume needed below it. Examination therefore includes the groove and cheek, not only the most prominent part of the bag.[1]
The assessment looks at fat prominence in different gaze positions, existing asymmetry, cheek projection and the position of the lower lid. Age provides context, but tissue findings explain which operation is being proposed. Bring details of previous eyelid procedures so the surgeon can understand how the fat and supporting layers were treated.[1][2]
When does excess skin change the approach?
A skin approach places an incision beneath the lower lashes and permits removal of redundant skin. Fat can also be repositioned through that access. The skin-approach fat-preserving operation is often called ハムラ法 in Japan. Skin removal and fat movement serve distinct purposes and should each have a reason in the plan.[1]
If the eyelid is loose, the surgeon may add a procedure to support its outer corner. The decision is based on the lid examination. Ask which finding makes support necessary and whether it changes the planned incision, follow-up or recovery arrangements.[1][2]
| Operation | Access | Fat treatment | Skin treatment |
|---|---|---|---|
| Transconjunctival removal | Inner lower eyelid | Reduces projecting fat | No skin removed through this incision |
| Transconjunctival repositioning | Inner lower eyelid | Moves fat beyond the orbital rim | No skin removed through this incision |
| Skin-approach repositioning | Below the lower lashes | Moves fat toward the hollow | Allows excess skin removal |
The incision determines whether skin can be removed through the same access.[1] ASPS procedure guidance, checked 4 November 2026
What should the preoperative examination cover?
Relevant history includes eye operations, previous under-eye treatment, dry-eye symptoms and current medicines. The examination considers skin, fat projection, the tear trough, lid position, lid closure, horizontal looseness and the relationship between the eye and cheek. These findings help explain the extent of surgery.[1]
Describe the change you want in concrete terms: less projection, a shallower groove or less redundant skin. At AVANT Plastic Surgery in Sinsa, ask how the proposed tissue changes correspond to those priorities and request a copy of the agreed plan.
How the surgical day is organised
Step 1 of 3: Confirm the plan
Review the incision, fat treatment, any skin removal and any support procedure. Confirm anaesthesia and the arrangements for leaving the clinic.[1]
Step 2 of 3: Carry out the agreed operation
The surgeon accesses the fat through the planned incision, removes or redistributes it and treats skin or support where indicated.[1][2]
Step 3 of 3: Review care and follow-up
Receive medication instructions, wound-care guidance and the review appointment. Ask separately about skin stitches and any external fat-fixation sutures.[1]
What risks belong in the consent discussion?
Possible effects and complications include swelling, bruising, conjunctival swelling, dryness, asymmetry, contour irregularity and incomplete correction. Other concerns include skin scarring, lower-lid retraction or outward turning, difficulty closing the eye, infection and double vision. Bleeding within the orbit can threaten sight.[1][2][5]
A 2024 systematic review pooling fat grafting and repositioning included 33 studies and 4,671 patients; its estimated overall complication rate was 11.2%. This mixed-procedure estimate is not a rate for transconjunctival repositioning alone.[5]
Sudden loss of vision or severe eye pain needs immediate contact with the surgical team or emergency eye care.[1]
What should you ask at the consultation?
What will you do to the bag and the hollow?
Why it matters. They may require different tissue changes.
What a good answer includes. Identifies the projection, the groove and the fat to retain or move.
Treat with caution. Names an operation without explaining the target.
Why would I need skin removal or lid support?
Why it matters. These operations have separate purposes.
What a good answer includes. Connects each addition to an examination finding.
Treat with caution. Lists additions without explaining their role.
Who reviews me after surgery and after I travel home?
Why it matters. The operation needs a follow-up plan.
What a good answer includes. Names the responsible role, appointments and out-of-hours route.
Treat with caution. Leaves the return-home arrangements undecided.
Common questions about repositioning and removal
Are repositioning and removal the same operation?
They can use the same inner-eyelid access, but moving fat and reducing it are different actions.[1]
Does an inner-eyelid incision remove loose skin?
No skin is removed through that incision. Any skin treatment needs its own explanation in the plan.[1]
References
(6)
Bibliographic records retrieved from PubMed (U.S. National Library of Medicine).
Bhattacharjee K, Ghosh S, Ugradar S, et al. Lower eyelid blepharoplasty: An overview. Indian J Ophthalmol. 2020;68(10):2075-2083.
Nahai F, Niazi F, Nahai F, et al. An Overview of Surgical Approaches for Lower Eyelid Blepharoplasty. Aesthet Surg J. 2023;43(12):1429-1440.
Memon SF, Wilde CL, Ezra DG. Lower Eyelid Surgical Anatomy and the Implications for Blepharoplasty Surgery: A Systematic Review of Anatomic Studies in the Literature. J Craniofac Surg. 2025;36(2):709-716.
Sarkar R, Ranjan R, Garg S, et al. Periorbital Hyperpigmentation: A Comprehensive Review. J Clin Aesthet Dermatol. 2016;9(1):49-55.
Xu Z, Zheng F, Zhao X, et al. Complications of Fat Grafting and Repositioning for Correction of Lower Eyelid Pouch With Tear Trough Deformity or Lid-Cheek Junction: A Systematic Review. Ann Plast Surg. 2024;93(3):e9-e25.
Yang F, Ji Z, Peng L, et al. Efficacy, safety and complications of autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis. PLoS One. 2021;16(4):e0248505.