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Youthful Lower Eyelid Fullness

Youthful lower eyelid fullness is commonly seen in younger Asian females. Essentially, it is a bulge of tissue immediately under the lower lash line that creates puffiness under the lower eyelid. Different from eye bags which can make one appear tired and aged, youthful lower eyelid fullness gives the appearance of youthful, friendlier eyes as it is associated with smiling. Anatomically, it is a result of increased hypertrophy of the orbicularis oculi (under eye muscle), which becomes more pronounced when one smiles. This is a highly desired feature in South Korea and other Asian cultures. Koreans call youthful lower eyelid fullness “aegyo-sal”; aegyo meaning cute and charming.

Youthful lower eyelid fullness is sought out by both younger and older patients who lack the trait and by older patients who have diminished fullness as a result of atrophied eye muscles, a common phenomena of aging.

There are three ways to achieve youthful lower eyelid fullness:


Youthful lower eyelid fullness procedure can be done in combination with lower eyelid surgery (see Lower Blepharoplasty). Using the same incision site created for the lower blepharoplasty, the surgeon can create youthful lower eyelid fullness by suspending the orbicularis oculi muscle back to its original position. The advantage of this method is that the surgeon is using the patient’s own muscle in order to best mimic the natural youthful lower eyelid fullness.


Youthful lower eyelid fullness can also be achieved with use of a filler. Compared to other fillers, Restylane® is preferred. The composite of Restylane® is ideal for this procedure as it has less tissue spread than other commercial fillers. There is close to no recovery time and one can typically resume with their normal schedule immediately after the procedure. One drawback in creating youthful lower eyelid fullness with use of filler is that the results can appear overdone and unnatural. In order to get naturally looking results using this technique, the surgeon must be very skilled and knowledgeable of the intricacies of this procedure. Results typically last one and a half to two years.


Fat grafting is the transferring of one’s own fat tissue to different areas of the face and/or body to create more volume. Fat is taken from areas of the body such as the abdomen, thigh, or hip area and then processed for reinjection in other areas such as the chin, temples, nose, eyes, breasts, and other areas of the body. Fat grafting is a great way to create youthful lower eyelid fullness with results that could last permanently. A downside to fat grafting is that your body tends to reabsorb 30 to 50% of the injected fat, potentially requiring repeated treatments. There also may be a few days to weeks of post-operative swelling and bruising.