• #2-1. Added indication: Lower eyelid fat removal



    The excellent effects of AGNES in acne is widely known and does not need further mentioning. I thought AGNES could be applied in other conditions considering its benefits in acne. The first additional indication I tried was syringoma. In 2010, Dr. Shi-hyung Cho of Gowoonsesang Dermatology in Busan suggested the idea and published a paper in Annals of Dermatology. One day, while I was treating lower eyelid syringoma, I observed that the lower eyelid wrinkles had also improved.


    The lower eyelid wrinkles had been difficult to address due to the very thin skin of this area (1mm or thinner). HIFU or radiofrequency (RF) cannot deliver energy into this thin layer of dermis. It is nearly impossible to selectively deliver the energy to the dermis while protecting the epidermis from burn. However, the W needle of AGNES is an insulation-coated microneedle of at most 1mm in length and is able to selectively deliver energy only to the dermis of the eyelid. This means that AGNES can safely tackle wrinkles in both the upper and lower eyelids.


    On the other hand, lower eyelid fat requires a different approach. Lower eyelid fat pads develop with age due to weakened tension in the orbital septum that surrounds the lower eyelid skin and fat pad, which leads to herniation of the infraorbital fat. That is, the lower eyelid dermis loses density becoming susceptible to wrinkles and the orbital septum loses tension allowing fat to protrude.


    Surgery was mainly the only available modality of lower eyelid fat removal. I had been performing surgical lower eyelid fat removal since 1997. However, surgical methods had serious risks and limitations. Laser-assisted transconjunctival blepharoplasty deepened the lower eyelid wrinkles, leaving the skin like a deflated balloon. Lower eyelid incision carried a risk of ectropion or an undesirable outline of the eye due to damaged orbicularis muscle. Most patients are averse to surgery, which is another hurdle to these treatments. For these reasons, noninvasive lower eyelid fat removal was needed.


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    Tests using lower eyelid fat samples obtained from surgical removal


    I thought developing a noninvasive lower eyelid fat removal could open a new market for the field of aesthetic medicine. The lower eyelid fat is a common sign of aging found in almost everyone. In fact, one of the most common questions that I receive from other doctors during my talks in academic conferences or fairs abroad is ‘how can they effectively remove lower eyelid fat without surgery?’ I started researching ways to use AGNES in lower eyelid fat. For months, this question was all I could think about. I decided to review pathophysiology and anatomy of the lower eyelid fat. 


    -To be continued

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