Avoiding regret with non-incisional under-eye fat removal: distinguishing between hollowing and incomplete fat removal

Common regrets after non-incisional under-eye fat removal are incomplete removal of fullness and hollowing from over-removal. Which is more likely depends not only on the prominence of the fat but also on the extent of under-eye grooves and skin sagging. It is important to note that the non-incisional approach is suited only to people with minimal excess skin.

What are the common reasons for regret?

Among complaints received from under-eye surgery, the most common reason was "fullness not completely removed."[1]This is a study analyzing 138 complaints related to eyelid surgery over 7 years.[1]

Conversely, there is also concern about hollowing from over-removal. It has been pointed out that with conventional methods that only remove fat, under-eye grooves do not improve and hollowing may become more noticeable.[2]

How can over-removal and incomplete removal be prevented?

Prevention depends on balancing the amount removed with the amount left and transferred. In recent years, methods that not only remove fat but also transfer it to the under-eye groove area to fill it have been used.[2]

However, in people with abundant fat, if too much is left, the cheek area may become overly full.[3]A study of 97 patients reported that preventing over-fullness was possible by carefully cutting away only the excess fat.[3]

Who is not suited for the non-incisional approach?

People with noticeable skin sagging or excess. Non-incisional fat removal is suited to young people with distinct fat fullness and minimal skin excess, as stated in a review article.[4]It has been reported that mild to moderate eyelid laxity is also suited for the procedure.[5]

Cases where eyelid margin inflammation exists, undetected dry eye is present, less than 6 months have passed since vision-correction surgery, smoking, or taking blood-thinning medication are situations where surgery should be postponed or the timing adjusted.[5]

How often do hollowing and incomplete removal occur?

In a study of under-eye fat removal with subsequent injection of refined fat, fine lines increased in 5.5%, grooves did not fully resolve in 2.7%, fullness recurred in 1.6%, and hollowing occurred in 1.1%.[6]

This study involved young Chinese subjects and fat injection was performed simultaneously.[6]These are not numbers for fat removal alone, but they show that incomplete removal and hollowing can occur at certain rates.

How long do swelling and eye discomfort persist?

Swelling occurs in nearly all patients. In a study of 97 patients, swelling resolved within 8 weeks.[3]Scleral puffiness occurred in 2.1% and resolved within 2 weeks; cheek numbness in 3.1% and resolved within 3 weeks.[3]

A comparison shows that the appearance of excessive scleral show was 3% with the non-incisional method and 28% with the skin-incision method.[4]This is one of the advantages of the non-incisional approach.

What to confirm before treatment

There are 3 guidelines to consider. First, whether the fullness is caused by fat alone or also involves grooves and skin sagging.[4][2]Second, whether fat is only removed or methods involving transfer are combined.[2][3]Third, your eye condition, existing conditions, and any medications you take.[5]

How much to remove and how much to leave must be decided by examining your under-eye area in person. Please confirm with your doctor during consultation whether the non-incisional approach is right for you.