• #2-3. Added indication: Lower eyelid fat removal



    AGNES’s mechanism of action in lower eyelid fat.

    1. Strengthening the tension of skin layers

    2. Orbital septum tightening

    3. Volume reduction of lower eyelid fat 


    Cleansing and make-up are possible on the next day of the procedure. The treatment causes little disturbance in daily activities and can be repeated after one month to continue or enhance the effect. I was able to develop lower eyelid fat removal with AGNES, an entirely new area of treatment, for the following reasons.


    First, the manufacturer was also a plastic surgeon. Second, I was equipped with understanding of the etiology of lower eyelid fat protrusion as well as anatomical knowledge of the eyelid skin and depth of the orbital septum.




    Good outcomes can be achieved through good understanding of the treatment.  




    The first patient to receive the lower eyelid fat removal with AGNES was my mother. The outcome was better than I first expected and she received a second treatment. The photographs I took of the treatment area two years after the final treatment shows that the outcome is still maintained.


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    The lower eyelid fat removal is not possible just because you have the right device. It also requires knowhow on the part of the doctor. For example, just inserting the needles is not going to bring good results when treating the eye area. The skin of target area should be pulled apart with both hands to create tension and the needle should be inserted at a 90º angle. The eye area has very soft and loose skin and does not allow correct insertion of the insulated part of the needle. The force of the insertion pushes the skin around the needle to roll inward. This can cause a burn or suboptimal outcome. 


    Moreover, it is important to accurately locate the fat when placing the needle into the lower eyelid fat. For this, use the left hand to gently press down for protection and simultaneously push the lower eyelid fat outward. Press the inner corner of the lower eyelid with a fingertip and push downward to make the fat pad protrude. This technique can be learned more accurately by observing a demonstration. The surgeon’s skills play an important role in the lower eyelid fat removal with AGNES.


    The most common side effect of this procedure is bruising. Bruises are caused by ruptured blood vessels and naturally disappear with time. To minimize bruising, inject epinephrine + lidocaine and press down on the bleeding area with a cue tip. Many doctors also worry about damaging the eye with the needle. When you use the left hand to protect the eyeball and push out the lower eyelid fat, it is impossible to damage the eyeball with the needle.


    A thick angular vein courses through the medial pocket of the lower eyelid fat, which can pose a great risk. It is rare, however, if bleeding is not controlled effectively during the procedure, the accumulated blood can cause hematoma which can lead to vision loss. However, AGNES uses RF that coagulates blood vessels and does not carry this risk even when the needle touches the angular vein. Even if this vein is damaged, applying pressure for about 5 minutes after the procedure is sufficient for hemostasis. One should fully insert the insulated part of the needle into the skin to avoid burning.


    Lower eyelid fat removal using AGNES is a small innovation that provided a new solution to the lower eyelid fat. I believe this new indication is as meaningful as the acne treatment that Toshio Kobayashi developed. I feel proud of the fact that I was able to contribute a new treatment to the field of aesthetic medicine. 


    -To be continued





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