1. Opening Hook
Under-eye circles—is "just removing the fat" already outdated? The correct answer for choosing a technique without failure.
"What You'll Learn in This Article"—5 Bullet Points
[What You'll Learn in This Article]
- Not "removing" but "moving"the Hamra method's decisive difference from ordinary fat removal
- The mechanism and indications of the "internal Hamra method" that leaves no scar on the face at all
- The power of the "external Hamra method" that lifts together with severe skin sagging
- A judgment flow to figure out the technique that suits you and to avoid failure
- The real downtime and post-op course data you should know first
Empathy text, 150–200 characters
The under-eye bulges and dark circles you notice every time you look in the mirror. You're often asked "are you tired?", and you've probably felt the limits of hiding them with concealer. When you research under-eye-circle surgery, jargon like "Hamra method" and "internal Hamra" lines up, and you end up unsure which suits you. For you who are considering treating your circles, this article thoroughly explains—clearly—from the differences between techniques to their pros and cons.
2. What Is the Hamra Method?
Wait, You Don't Discard the Fat? The Hamra Method Is a Paradigm Shift of "Utilizing the Fat"
Past circle treatment was dominated by the technique of "cutting away the protruding fat (fat removal)." However, a procedure that merely removes fat carries the risk of the under-eye area becoming hollow and wrinkles becoming conspicuous in the future.
The groundbreaking technique born in response is theHamra method (orbital fat repositioning). Rather than "discarding" the excess fat causing the bulge, it "moves and lays" it into the hollow (groove) beneath, smoothing the eye area flat.
The key to this surgery is the technique calledArcus marginalis release (release of the orbital-rim periosteum). * Jargon note: Beneath the eye is a periosteum (a firm membrane) that dams the fat from falling down. Cutting (releasing) this membrane is what first allows the fat to be smoothly pulled down toward the under-eye hollow.
With this technique, it exerts a dramatic effect of plumping up (flattening) from the inside, using one's own fat, the deep tear trough just below the bulge and the Gorgo line (midcheek groove) running diagonally across the cheek.
3. The Internal Hamra Method
The Internal Hamra Method (Transconjunctival Approach)—A Choice That Leaves No Scar on the Face at All
Overwhelmingly supported by those who feel "putting a scalpel to the face is scary" is the internal Hamra method.
Oh, You Cut From There? Details of the Surgical Approach (Access From the Conjunctival Side)
The internal Hamra method makes a few-millimeter incision on the red mucous-membrane (conjunctival) side visible when you make a face, and moves the fat from there. Because the skin surface is not cut at all, no sutures or scars remain on the face surface.
People Suited to Internal Hamra (Indication Cases)
This technique is best for those, mainly in their 20s to 30s, who"have bulges and a tear trough but little skin laxity". Because skin cannot be excised, it is not suited to cases where the skin itself is excess and sagging.
The Overwhelming Advantage of Internal Hamra
The biggest advantage is that"there is completely zero scar on the face surface"Furthermore, because damage to the skin and orbicularis oculi muscle is minimized, compared with the external Hamra method described later, thedowntime is short.
Drawbacks and Limits You Should Know
Because skin cannot be excised to lift, it is not suited to improving severe Gorgo lines or the serious skin sagging and wrinkles that come with age.
Regarding the efficacy of the transconjunctival approach (internal Hamra), many cosmetic-surgery society journals and other literature have also reported the medical data that "in the laxity-free young-to-middle-aged patient group, the complication risk is markedly low and long-term satisfaction is high."
4. The External Hamra Method
The External Hamra Method (Transcutaneous Approach)—A Choice That Lifts Together With Severe Wrinkles and Sagging
On the other hand, the external Hamra method can approach over a wider area for years of accumulated sagging and deep wrinkles.
Details of the Surgical Approach Targeting Right at the Lash Line
The skin 1–2 mm below the lower lash line is directly incised. From here, while moving the fat to the hollow (the Hamra method), the excessively stretched skin and slackened muscle (orbicularis oculi) are pulled taut and excised.
People Suited to External Hamra (Indication Cases)
"Not only bulges, but also deep Gorgo lines and severe skin sagging and crepey wrinkles"It is indicated for those in their 40s and beyond, or those whose skin has become excess from a past fat-removal surgery.
Three Birds With One Stone? The Advantages of External Hamra
In addition to eliminating circles and flattening deep grooves (tear trough, Gorgo line),"removing lower-eyelid sagging (liftlift)"is completed simultaneously—this broad adaptability is the biggest appeal. The rejuvenation effect on the eye area is immense.
Drawbacks and Risks You Should Be Prepared For
A fine linear scar remains just below the lashes (within a few months it turns white and fades to a degree coverable with makeup). Also, because of wide undermining from the skin side, swelling and bruising tend to make thedowntime drag on. Rarely, it also carries the risk of the lower eyelid everting (becoming a face-making state) due to excessive skin excision.
5. Internal Hamra vs. External Hamra
Internal Hamra vs. External Hamra—When in Doubt, Look Here! The Ultimate Judgment Flow
For those who, having read this far, are still unsure "which should I choose after all?", we've prepared a clear judgment flow. Please compare and choose along the following axes.
- [Skin Laxity] Present (excess enough to pinch) ⇒ External Hamra / Absent (firm) ⇒ Internal Hamra
- [Tolerance for Scars] Don't want even 1 mm left on the face ⇒ Internal Hamra / Can tolerate a temporary scar for the sake of a lift ⇒ External Hamra
- [Time Off (Downtime)] Can only take a few days to 1 week ⇒ Internal Hamra / Can secure about 1–2 weeks ⇒ External Hamra
6. Post-Op Course and Satisfaction Data
"Until When Does the Swelling Last?" The Truth About Post-Op Downtime You'd Want to Know First
To state the conclusion first, the downtime of circle-removal surgerypeaks on "days 2–3 post-op". To prepare you mentally, we'll tell you the real progression of the course.
- Days 1–3 post-op: Strong swelling like you've cried your eyes out. The period when bruising (reddish-purple) is most likely to appear.
- One week post-op: Strong swelling subsides, and bruising turns yellow to green. With internal Hamra, it can mostly be covered with makeup at this point. (With external Hamra, suture removal is done around this time.)
- 2 weeks to 1 month post-op: Puffiness also subsides, settling into a near-complete natural state.
Furthermore, the frequency of cases requiring reoperation (revision) is around a few percent of the total. The main reasons are "insufficient fat-movement amount leaving a hollow" and "asymmetry appeared," but if you choose a physician with accurate diagnosis and high skill, the risk can be minimized.
7. Summary
If You're Wondering "What About My Case?"
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Summary—It's Not "Which Is Correct" but "There's a Technique That Suits You"
How was it? The important points of this article are as follows.
- The Hamra method is a rational technique that does not "discard" the fat but "moves it to fill the hollow."
- Internal Hamrais for those with little sagging who don't want a scar and want to shorten downtime.
- External Hamrais for those who want to lift skin sagging and deep wrinkles simultaneously.
- There is more than one correct answer; the indication differs by your skin condition and bone structure.
Which suits the state of your eye area cannot be judged without actually feeling the amount of excess skin and the amount of fat. We recommend first receiving a consultation and indication diagnosis by a specialist at a trustworthy clinic that does not engage in pushy sales. Your eye-area concerns will be resolved, and days when looking in the mirror becomes something to look forward to will surely come.
References
About the Author
Hiromitsu Nakamura M.D.
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
Has a track record of research presentations at domestic and international conferences, and is also involved in technical guidance and education across Zetith Beauty Clinic. Specializing in precise eye-area treatment based on anatomical evidence, he pursues natural results tailored to each person's bone structure and tissue.