Complete Guide to Under-Eye Fat Repositioning Surgery (Hamra Technique)

For those concerned about dark circles and puffiness under the eyes

A clear explanation of lower eyelid fat repositioning surgery (Hamlra method), which “does not remove fat”

“I’m concerned about dark circles and puffiness under my eyes”
“I’m worried that surgery to remove fat may cause hollowness in the future”

One option that those with such concerns should know about is lower eyelid fat repositioning surgery (Hamlra method).

In this article, we will explain the concept behind the Hamlra method, differences in techniques, expected changes, downtime, and points to keep in mind in an easy-to-understand manner.
※This article is intended to provide general information only; suitability and treatment plans may vary depending on the doctor’s examination.

What is the Hamlra method?

A treatment that “repositions and smooths” rather than “removing excess fat”

The Hamra method (Hamra procedure) emphasizes not removing too much fat that causes puffiness under the eyes,

and uses an approach that moves (repositions) the fat downward to smooth out the transition with the hollows.

With conventional treatment involving “fat removal only,” depending on individual characteristics and age-related changes, it may eventually tend to make hollows more noticeable.

The Hamra method aims to reduce this risk while creating a more natural transition from the lower eyelids to the cheeks.

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Two surgical techniques: Transcutaneous Hamra method / Transconjunctival Hamra method

Which is more suitable depends on the “amount of excess skin” and the “degree of sagging”

1) Transcutaneous Hamra method (transcutaneous approach)

This method involves making an incision near the lower lash line and, in addition to fat repositioning, allows for skin and muscle adjustment as needed.

Suitable tendencies

• ・　There is a relatively significant amount of excess or sagging skin

• ・　You want to address wrinkles and sagging comprehensively

• ・　You want to address both fat protrusion and skin sagging at the same time

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Points to note

• ・　Because the incision is made from the outside, redness or firmness may appear during the healing process (in many cases, these tend to settle over time).

2）Reverse Hamra method (transconjunctival approach)

Because the approach is made from the inner side of the lower eyelid (conjunctiva), a key feature is that visible surface scars are less likely to remain.

Suitable tendencies

• ・　There is little excess skin, and you are mainly concerned about fat protrusion or a contour step

• ・　You want to make scars as inconspicuous as possible

• ・　You are relatively young and your skin elasticity is still well maintained

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Points to note

• ・　When there is a significant amount of excess skin, the transconjunctival approach alone may not provide sufficient improvement.

Expected changes

Not only the impression of “bulging,” but also the impression of “shadows (contour steps)” is improved

The goal of the Hamra procedure is not simply to reduce fat, but to
smooth the boundary (step-off) between the lower eyelids and cheeks, making shadows appear less noticeable.

Commonly expected benefits

• ・　The under-eye bags become less noticeable

• ・　The appearance of the step-off (shadow) along the tear trough and beneath the lower eyelid bag is softened

• ・　May help reduce an appearance of looking “tired” or “older”

※The results may vary depending on bone structure, skin thickness, fat volume, and the degree of sagging.

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Approximate downtime

Swelling and bruising peak after a few days, while the final results stabilize gradually

In general, the postoperative course often proceeds as follows (individual variations apply).

• ・　Several days after surgery: A period when swelling and bruising are more noticeable

• ・　1–2 weeks: The unusual appearance gradually becomes less noticeable

• ・　1–3 months: The texture and asymmetry settle, making the result more likely to look natural

For the subciliary Hamra procedure, guidance varies by clinic, including the timing of suture removal and when makeup can be resumed.

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Important Points to Know (Important)

For lower eyelid surgery, careful management of the “position (shape) of the eyelid” is extremely important

In lower eyelid surgery, it is important to consider not only the final appearance but also functional aspects (eyelid position, dryness, and discomfort).

The literature also emphasizes the importance of evaluating eyelid laxity before surgery and considering fixation or reinforcement when necessary.

Potential risks (examples)

• ・　The position of the lower eyelid may appear changed (drooping, ectropion, etc.)

• ・　Dryness, a gritty sensation, and swelling may persist

• ・　Asymmetry, uneven contours, and residual or unevenly pronounced bulges

• ・　Possibility that additional treatment or revision may be necessary

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Systematic reviews have also concluded that lower blepharoplasty (cosmetic lower eyelid surgery) is generally highly safe, while

functional and aesthetic complications (such as changes in eyelid position and dry eye symptoms) may be factors leading to revision.

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Points to check when choosing a clinic

What matters is not “Which procedure is best?” but “Is the plan right for you?”

Things to confirm during the consultation

• ・　Which is more suitable for your condition—transconjunctival or transcutaneous—and why

• ・　How they evaluate not only the bulging fat, but also the depressions, excess skin, and bone structure

• ・　Whether the risk explanation is specific, including eyelid position, dryness, and asymmetry

• ・　Postoperative follow-up, communication arrangements, and the approach to handling issues when necessary

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Rather than deciding based only on “because it’s cheap” or “because it leaves no visible scar,” it is recommended to prioritize confidence in the treatment design and explanation.

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Summary

The Hamra procedure is a treatment that aims to naturally improve the appearance of hollows and shadows under the eyes by taking the approach of “repositioning” rather than “removing” the fat under the eyes.
However, because the lower eyelid is a delicate area, determining suitability and conducting a preoperative evaluation, including eyelid laxity, are important.

If you are concerned, start by carefully confirming with a doctor which method is right for you and what degree of change is realistically achievable.