Removing lower eyelid fat empties the eye socket and can look older at fifty than the bags did. Moving the same fat down into the hollow fixes both problems at once.
The bulge under the eye and the hollow below it are usually the same problem: fat that has slipped forward over a ligament, leaving a groove where the cheek begins. Cutting the fat away flattens the bulge but leaves the groove, and over the following decade the socket looks increasingly skeletal. Releasing the ligament and laying that fat into the hollow removes the bulge and fills the shadow with the patient's own tissue, in a single manoeuvre.
In most patients under fifty the whole operation is done through the inside of the lower lid, so there is no external scar at all. That approach also avoids cutting the muscle that holds the lid against the eye, which is what causes the pulled-down, rounded lower lid seen after older techniques. When loose skin has to be removed as well, a fine incision just under the lashes is added, and skin is trimmed conservatively, a millimetre or two rather than more.
Not every dark circle is fat. Pigmentation, thin skin showing the muscle underneath, and allergic congestion all produce shadows that surgery cannot touch, and operating on them produces an unhappy patient with an unchanged face. A very large fat pad in an older patient may need a small amount removed as well as repositioned. We assess this by looking at the eye from the side and by asking you to smile, since a groove that vanishes on smiling behaves differently.
Bruising after lower lid surgery is more dramatic than after the upper lid and often spreads down the cheek, peaking around day three and fading over two to three weeks. Swelling can be asymmetric for a month, and the transposed fat feels firm before it softens. Sleeping propped up for a week and cold compresses for the first forty-eight hours make a measurable difference. Eyelid surgery is €1,800, and combined upper and lower work is quoted before you fly.
For a genuine fat bulge with a groove beneath it, surgery treats the cause once rather than topping up filler every year. For a hollow with no bulge at all, filler is often the more sensible starting point.
It is fixed into a pocket under the cheek tissue and heals in place, so it does not slide back. It does behave like the rest of your facial fat afterwards, growing and shrinking with your weight.