Under-eye bag and dark-circle treatment in Kobe | Minato Motomachi Beauty and Plastic Surgery Clinic

Under-eye concern checklist

The appearance and course of under-eye concerns differ from person to person.

Others say I look tired even after I have rested

Fullness under the eyes with a shadow immediately below

A deep groove at the lid-cheek junction

Long-standing blue, purple, or brown discoloration under the eyes

Fine lines under the eyes become prominent when smiling

The concern is difficult to conceal with makeup alone

It is often difficult to understand the treatment by self-checking.

Lighting and facial expression change how shadows appear, and fullness, hollowing, and pigmentation may coexist. Examination includes front and oblique views and assessment during eyelid movement.

STRUCTURAL CAUSES

Causes of under-eye shadows
Readable from structure

01

Skeletal support and soft-tissue hollowing

A structural illustration of under-eye treatment that indicates the skeleton and the hollowing of the eye around the orbit

Age-related changes in the orbital skeleton and cheek support can create a groove at the lid-cheek junction, making shadows more visible under directional light.

02

Protruding orbital fat

A structural illustration of a under-eye treatment that indicates the front protrusion of the orbital fat and the swelling under the eyes

When orbital fat protrudes forward, it creates lower-eyelid fullness and a shadow directly beneath it, making the under-eye area look darker.

03

A combination of protrusion and hollowing

Protrusion and hollowing may coexist. Their relative contribution determines which treatment is prioritized and what should be reassessed afterward.

LOWER EYELID ANATOMY

Orbital fat and
Under-eye step

Lower-eyelid orbital fat is divided into medial, central, and lateral compartments. Protrusion may differ by compartment and between the two sides.

Fat removal is not performed uniformly. We assess pre-existing hollowing and the lid-cheek contour, identify which fat compartments create the shadow, and tailor the amount removed.

Under the eyes, the skin is thin, and the slight step is a shadow. It is not necessary to have a lot of resection, and it is important to determine the candidacy and balance.

An ical illustration of the upper eyelid center, inner fat pad, tear gland, outer eyelid, middle and inner fat pad, and the lower eyebrow fat

TYPES

Four common under-eye presentations

SHADOW

Shadows from contour changes

Orbital fat protrusion or under-eye hollowing creates a contour step that appears dark in shadow; its prominence changes with lighting and head position.

HOLLOW

Under-eye hollowing

A groove at the lid-cheek junction may reflect reduced support or volume and create a shadow; it may coexist with protruding fat.

VASCULAR

Blue or purple discoloration

Thin skin, visible vessels, or venous congestion can create blue or purple discoloration; structural treatment alone may not provide sufficient change.

PIGMENT

Brown pigmentation

Brown discoloration may reflect pigmentation after friction or inflammation. We consider friction-reducing care and treatment selected for the pigment pattern.

TREATMENT STRATEGY

Depending on the cause
Under-eye treatment Policy

Fat scented under-eye concerns consider scents for fat removal, bone absorption and hollowing scented under-eye concerns, and if necessary to re-evaluate after a month, the flow of cure for additional treatment — We will take care according to the cause and re-evaluate the time

Cause-and-treatment comparison. Left: fat, often present from a younger age, with protrusion as the main feature → fat removal; the medial and central fat are not over-resected, and the procedure is designed to avoid creating a hollow. Right: bone resorption, noticed mainly over the past two to three years, with hollowing as the main feature → hyaluronic acid, used to provide support rather than simply “fill in” bone. Post-fat-removal review sequence: immediately after fat removal → do not decide too soon → reassess at one month. The image states the clinic’s experience that more than 95% of patients feel no additional injection is needed. If hollowing remains after swelling, color change, and fine lines have settled, additional hyaluronic acid may be considered. If skin-quality concerns remain at one month—uneven color, dullness, or fine lines—the finishing step may use Juvelook, Pluryal, or related treatment as needed; this addresses skin quality rather than structure.

01
First assess protrusion and hollowing separately
Assess fat protrusion, skeletal support, the lid-cheek junction, and skin condition separately.
02
Address the main structural factor first
When protruding orbital fat is the main factor, we consider transconjunctival fat removal without confusing it with treatments intended for hollowing.
03
Reassess after postoperative swelling subsides
Do not decide on every treatment immediately; reassess residual hollowing, pigmentation, and fine lines after swelling has settled.

TREATMENT OPTIONS

Under-eye treatment options

We recommend options based on examination findings, the desired change, acceptable downtime, and budget.

01

FOR UNDER-EYE BAGS

Transconjunctival lower-eyelid fat removal

This procedure approaches orbital fat through the inner surface of the lower eyelid and adjusts the fat that protrudes forward. It leaves no skin incision, but risks include swelling, bruising, asymmetry, and hollowing.

Possibilities: When protruding fat and the shadow below it are the main concerns
Treatment Philosophy: Assess the site and volume of protrusion and avoid over-resection

An y illustration of the upper eyelid and lower eyelids to confirm with transjunctival fat removal

02

FOR HOLLOWS & SHADOWS

Hyaluronic acid injection

When under-eye or midface hollowing and reduced skeletal support create a shadow, hyaluronic acid may be injected at a selected site, layer, and amount. It may not be suitable when fat protrusion is pronounced or the area is prone to edema.

Possibilities: When hollowing or reduced support is the main concern
Treatment Philosophy: Restore support in context rather than simply filling the hollow

Packages and syringes of hyaluronic acid formulation Juvidam Vista used at our clinic

Package and syringe labeling: Juvéderm Vista VOLUMA XC, injectable gel with lidocaine, two 1.0 mL syringes; product codes visible include 30354, VB20, and 453813A10; storage wording indicates room-temperature handling below 25°C; manufacturer: Allergan.

03

FOR SKIN QUALITY

Localized Juvelook injection and related options

If uneven color, dullness, or fine lines remain after structural treatment, skin-quality treatment may be considered. It does not treat protrusion or deep hollowing itself.

Possibilities: If you are worried about skin texture and fine wrinkles
Treatment Philosophy: Consider adding if necessary after evaluating the structure

Our doctors will guide you to the examination and treatment policy of under-eye treatment

OUR POLICY

Our approach to under-eye treatment

CO2 laser for lower eyelid fat adjustment, check asymmetry at the back and seat position, and work with two doctors. — Treatment methods and procedures may vary depending on the patient’s results and the condition of the day.

01

Assess skeletal hollowing and fat protrusions

Fullness, hollowing, pigmentation, and thin skin may overlap. We determine whether the main shadow comes from fat protrusion or reduced skeletal and midface support.

Ill ration of the treatment of under-eye concerns to examine osteochondrial and soft tissue hollowing and protrusion of orbital fat

02

Adjust the amount removed according to the site of protrusion

Protrusion varies among the medial, central, and lateral fat compartments. We assess each compartment together with any pre-existing hollowing and adjust the amount removed to reduce the risk of over-resection.

Identification of the idea of adjusting the protruding site and quantity by confirming the fat of the three compartments of the lower eyelid

03

Reassess after recovery before deciding on additional treatment

Hollowing and pigmentation are difficult to judge while swelling or bruising remains. After recovery, we reassess whether residual hollowing needs hyaluronic acid or whether pigmentation and fine lines need skin-quality treatment.

Identifying the need for additional treatment by re-evaluating the eye until the swelling after treatment is calm

Our Approach

01

Simple is Best

Incisional or fat-repositioning procedures such as the Hamra or transconjunctival Hamra technique may be appropriate in a small proportion of cases with excess skin or marked hollowing. They do not prevent future age-related change; when future treatment options are considered, the clinic may recommend a simpler fat-removal approach.

02

Do not assume that fat grafting must be combined

Carefully planned fat removal can reduce the risk of hollowing, and many patients do not require fat grafting. Fat grafting also carries risks including swelling, nodules, infection, fat necrosis, and variable retention.

03

After additional treatment re-evaluate the need

Injection treatment is not always required after fat removal. Once swelling has settled, we reassess any remaining hollowing or pigmentation and recommend hyaluronic acid or skin-quality treatment only when needed.

CASE PHOTOS

Examples of Under-eye treatment

These in-clinic cases center on lower-eyelid fat removal and include combinations with hyaluronic acid and upper-eyelid or brow treatment. Review the treatment details and photography timing for each case.

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Preoperative and postoperative cases of laxity and conjunctival fat removal of upper eyelids

Clinical comparison: Before surgery → one month after upper-eyelid laxity surgery plus lower-eyelid fat removal.

CASE 01

Upper eyelid laxity + conjunctival fat removal

The upper and lower eyelids were treated after assessing the groove around the eyes and lower-eyelid fullness. The photographs compare before surgery with one month after surgery.