For optimal results, under-eye filler treatments must be personalized to the cause of hollowness. Beomgye, Pyeongchon, Beomgye Station, Pyeongchon Station, Hogye-dong, Bisan-dong, Gwanyang-dong, Dongan-gu, Indeogwon, Geumjeong, Anyang

​When addressing under-eye hollowing, consider a clinic that focuses on these factors

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A clinic capable of explaining the anatomical underpinnings: It is beneficial if the clinic can thoroughly describe, during consultation, the specific influences of tear trough ligament adherence, fat positioning, and skin texture variations.

A clinic that prioritizes manual adhesion release (separation): Choosing a clinic that carefully separates tissue adhesions using a cannula, a blunt-tipped instrument, rather than relying solely on automated devices, may be advisable.

A clinic implementing a 'space maintenance' step post-release: Beyond merely releasing adhesions, a thoughtful approach includes creating a physical buffer space. This step aims to help deter tissues from re-adhering.

A clinic that recommends treatments based on genuine necessity: Recommendations should be guided by clinical indications, not by trends, pricing, or popularity. It is prudent to select a clinic that does not initially suggest unnecessary procedures.

A clinic that provides insight into the possibility of recurrence: It is helpful to understand the quantitative and structural recovery mechanisms from a clinic that explains them clearly, rather than offering vague assurances about preventing reattachment.Clinical Insights: Addressing Under-eye Hollowing

Approach to Under-Eye Hollowing: Design Philosophy

The methods discussed on this page focus on enhancing under-eye hollowing, which may stem from

tear trough concavity, the visible prominence of orbital fat, and shadows resulting from thin, translucent skin.

Consultations and procedures are consistently performed with a

design-focused and evidence-supported methodology.

Key aims for improvement include:

mitigating structural disparities around the eyes,

discouraging re-adherence following tissue repositioning, and

stimulating the regeneration of dermal collagen volume.

1. Understanding the Causes of Under-Eye Hollowing

The periorbital region is subject to relatively swift three-dimensional structural alterations,

and because the skin in this area is notably delicate, even minor shifts can result in distinct shadows.

Under-eye hollowing typically arises from the interplay of three main underlying factors.

① Tear Trough Ligament: Posterior Adhesion and Retraction

The tear trough ligament is a band of fibrous tissue that offers support to the internal structures of the lower eyelid.

If this ligament develops excessive adherence and fixation towards the bone posteriorly,

or if it becomes retracted into a tightened state,

the overlying tissue volume can appear depressed.

Should this condition endure,

the inner aspect tends to show a depression, while the outer portion may seem to stand out,

This creates a marked contrast, often making the tear trough boundary particularly defined.

To illustrate, one might envision this scenario as

“a cushion being pressed down due to its underlying support structure being pulled and secured rearward.”

② Under-Eye Fat: Downward Displacement and Eye Bag Development

Orbital fat typically serves as a vital protective padding for the eye

and helps sustain balanced volume in the facial contours.

Nonetheless, with age, as the elastic fibers and fascial layers

—which are delicate supportive tissues of the face—start to weaken,

the fat pad shifts inferiorly and anteriorly, leading to a noticeable prominence.

If medial ligament adherence occurs concurrently,

the difference between the depressed and prominent areas becomes particularly pronounced,

causing the boundary line to seem markedly more distinct.

③ Skin Thinning, Structural Translucency, and Pigment-Related Shadows (Dark Circles)

As the skin's thickness diminishes,

underlying blood vessels can become more apparent, which may contribute to a darker hue in that area.

Furthermore, if melanin pigment accumulates around the eyes

due to recurrent minor irritation,

the brain might interpret this color variation as shadow and depth.

Put simply,

even without complete ligament adhesion,

the sheer color contrast can create the perception of under-eye hollowing.

2. Treatment Plans Based on Underlying Causes

Our procedures incorporate a stepwise methodology, carefully tailored to each specific underlying cause.

For this reason, even when treatment methods appear similar,

we suggest only what is necessary, ensuring it is neither excessive nor insufficient, all within an appropriate scope.

Tear Trough Adhesion: Cannula-Assisted Release + Establishing Volume-Maintenance Space

Instead of merely

it is crucial to selectively release only the adhesions between specific tissue layers

to create adequate space.

Employing a cannula enables safer dissection,

potentially resulting in less bruising and swelling compared to sharp needles.

After the adhesion has been released,

it is important to establish a physical buffer space

to deter the tissues from re-adhering and becoming fixed during the healing phase.

The approach used for this is collagen volumizing acupuncture, commonly known as the COVA procedure.

COVA Procedure: Design Philosophy and Expected Benefits

Immediate space creation + stimulation of delayed collagen rebuilding

A solid PDO-based material, often utilized as a surgical suture,

is carefully introduced between the ligament and the bone.

As this material gradually dissolves over approximately 6 months to 1 year,

it encourages the space to be gradually replaced by the patient’s own collagen

(the primary structural protein vital for skin elasticity).

Rather than a method that fills immediately and may disappear quickly, like conventional fillers,

this technique follows a structural rebuilding mechanism:

Micro-bleeding signal → stimulation of fibroblasts (the skin cells responsible for collagen production) → collagen deposition, leading to stable volume replacement

This aims for a natural-looking result with a minimal foreign-body sensation,

and serves as a volume-maintenance strategy that may be helpful in reducing the likelihood of recurrence.

Eye Bag Fat Displacement: Precise Fat Ablation Using Insulated-Needle Radiofrequency

When eye bags have already noticeably protruded,

volume reconstruction alone may have limitations in fully balancing the contrast.

In such situations, we apply insulated-needle radiofrequency-based fat ablation,

a technique engineered to deliver thermal energy exclusively at the needle tip.

For instance, this insulated-needle radiofrequency modality,

This is an insulated radiofrequency (RF) device,

It is designed to selectively deliver energy to a specific depth, which may help induce deep thermal sensation.

This process may soften and refine the boundary between protruding fat and surrounding tissues.

For dark circles, treatment often involves fortifying skin structure and designing approaches to minimize shadows.

If pigmentation is identified as the primary underlying cause,

considering a 1064 nm-based toning laser might be an appropriate approach.

When skin translucency is the significant contributing factor,

the focus shifts toward reconstructing dermal thickness.

Additionally, exploring methods to enhance regenerative signaling through skin boosters or combined regenerative stimulation is often considered.

To prevent over-stimulation of melanocytes,

a precise evaluation of pulse duration and depth targeting should be conducted beforehand.