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Hello, I am Yumi Hattori, a board-certified plastic surgeon at Bianca Clinic. I am Yumi Hattori, a plastic surgeon certified by the Japanese Society of Plastic Surgery at Bianca Clinic.

While researching to improve dark circles and sagging under the eyes, some of you may have seen the term "hamuloplasty aftereffects" and felt uneasy. Since the area around the eyes is a part that greatly influences the impression of the face, it is natural to be cautious about "what if there are aftereffects...". In this issue, we will tell you what kind of procedure the Hamra method is, why the aftereffects are talked about, and other points we want you to know to eliminate your anxiety, organized from a doctor's point of view.

What is the Hamra Method? A procedure to improve dark circles under the eyes “from the structure”.

Puffiness under the eyes and dark circles that cannot be hidden even with concealer can make the entire face look tired and give the impression of being older than one's actual age. In fact, many people come to us for consultation because of changes around the eyes. The Hamra method is one of the treatments for dark circles and sagging under the eyes. The main cause of sagging under the eyes is orbital fat that protrudes due to loose muscles, sagging skin, and ligamentous conditions. Instead of simply removing the orbital fat, it is moved and relocated to the hollow area to smooth out the bumps.

Most dark circles and shadow circles are not simply a matter of “too much fat/too little fat,” but are caused by the positional balance of fat. The Hamra Method is a procedure that approaches this "structural misalignment" and aims to flatten the under-eye area from the root.

Difference between Hamra Method and Back Hamra Method｜Points where misunderstandings about the aftereffects can easily arise.

There are two Hamra techniques: the hamula and the back hamula. There are differences in the location of the incision, as well as in the indications and downtime.

Hamra Method｜Treatment of dark circles approaching from the surface of the lower eyelid

The Hamra procedure is a treatment for sagging under the eyes in which an incision is made just below the lower lash line to comprehensively adjust the skin, muscles, and orbital fat. The main feature of this method is that it can simultaneously adjust the puffiness and indentation of the lower eyelid as well as the excess skin, thus allowing for a combined approach to dark circles and sagging skin. Because the incision is made on the front side of the eyelid, it is sometimes referred to as the Superficial Hamula Incision. Especially for those who have strong sagging skin or noticeable excess skin due to aging, a rejuvenating effect can be expected for the entire eye area.

Because an incision is made along the lower lash line, a temporary scar will appear after the surgery, but it will fade over time and in most cases will become less noticeable in about 1 to 3 months. Another feature is that the incision line follows the lash line, making it easy to cover with makeup.

▶Hamra method isHere

What is the Ura Hamula Method｜Treatment of dark circles approaching from behind the lower eyelid

The back hamula procedure is performed from the back of the lower eyelid to reduce the appearance of dark circles under the eyes by moving the protruding orbital fat into the hollow area. Because no incision is made on the skin surface, there are no visible scars. However, it is not possible to remove excess skin or strong sagging skin. Therefore, if sagging skin or wrinkles are noticeable, the back hamula procedure alone may not be sufficient to make a sufficient change.

▶The back hamula method isHere

Reasons why the Hamra method is said to cause aftereffects

The Hamra procedure is one of the most highly specialized surgical procedures for the eye area. Because the skin under the eyes is thin and densely packed with blood vessels, nerves, muscles, and fat, an accurate understanding of the periocular anatomy is a prerequisite. The following points are particularly important

• Ability to accurately determine the amount of orbital fat
• Design ability to move fat to any position.
• Subtle fine-tuning to minimize left-right differences

All of these processes require millimeter-by-millimeter control, and the physician's understanding of anatomy and experience will be reflected in the finished product. If the procedure is performed without sufficient knowledge and experience, it may cause the patient to feel "the result is not what I expected" or "discomfort remains" after the surgery.

What are the possible sequelae of the Hamra method?

The Hamra method is low-risk if properly diagnosed and operated on, but since it is a surgical procedure, the following sequelae have been reported in very rare cases.

• Lower eyelid ectropion...The lower eyelid is turned outward in a so-called "akkanbei" (akkanbei). This may occur when the amount of skin removed or the fixation balance is not appropriate.
• Dry eye...When the eyelid is difficult to close tightly due to lower eyelid ectropion, dryness and discomfort of the eye may occur.
• Entropion...A condition in which the edges of the eyelid warp inward and the eyelashes touch the eyeball. This can cause a foreign body sensation or pain.
• Corneal damage...Cases have been reported where the cornea is damaged when the lashes hit the cornea due to the effects of entropion and other factors.
• Perceptual dullness...Skin sensation around the lower eyelid area may be temporarily dulled. In most cases, recovery occurs over time.

These aftereffects rarely occur if the surgery is performed in the correct manner. However, since the possibility of their occurrence is not zero, it is important to understand the risks and take measures in advance.

Important points to avoid regrets in the aftermath of the Hamra method.

In order to avoid the risk of aftereffects of the Hamra Method as much as possible and to obtain highly satisfactory results, we will explain the points that must be kept in mind before the procedure.

Select a physician with experience and diagnostic skills.

The Hamra procedure is one of the most difficult eye surgery procedures. Therefore, it is very important to choose a cosmetic surgeon with sufficient experience in eye surgery when undergoing the procedure. We believe that the Hamra Method is a procedure whose results are largely dependent on the quality of the design and the surgeon. One guideline for selecting a doctor is as follows

• A large number of cases of treatment of dark circles and sagging under eyes
• Have good judgment to suggest other procedures depending on the condition, without being too particular about the Hamra method.
• Have a system in place to handle revision surgeries in case of emergency.

In addition, whether or not there is an explanation not only of the "effects" but also of the risks and disadvantages is an important factor in determining the doctor's sincerity. Be wary of explanations that emphasize only the convenient aspects and do not mention the disadvantages. Asking questions until you are satisfied and choosing a doctor who is willing to face you properly will lead to a procedure you will not regret.

Determine if the hamula method is really indicated.

While some people experience changes with the Hamra method, it is not suitable for everyone. Because the causes of dark circles and sagging under the eyes vary from person to person, misjudging the indications may result in insufficient change or discomfort.

At Bianca Clinic, in order to avoid aftereffects and unnecessary risks, we provide a consultation to carefully confirm from "whether the hamula method is really necessary" or not. For example, another procedure may be suitable in the following cases

• When the main cause of dark circles is pigmentation or poor circulation
• When sagging skin is the primary cause rather than orbital fat
• When the effect of skeletal and ocular protrusion is strong and difficult to improve by fat transfer alone

In such cases, forcing a hamula procedure may not only fail to produce the desired effect, but may also cause a decrease in satisfaction. A reliable doctor will not forcefully recommend a procedure that is not indicated. We believe that presenting the correct treatment options to you and allowing you to choose from among them with your satisfaction will ultimately lead to a procedure that you will not regret.

Understand side effects and downtime.

Symptoms such as swelling, internal bleeding, pain, and swelling may temporarily appear after the Hamra Method surgery. All of these are common reactions that may occur after surgery and will gradually subside over time. The estimated downtime varies depending on the surgical technique, but in most cases, swelling and internal bleeding settle down in about two weeks for the hamula method, which removes the skin, while the back hamula method, which does not cut the skin, tends to have a relatively low downtime of about 10 days.

However, if you judge for yourself that you will be fine because your symptoms are mild, the risk of residual discomfort may increase due to the way you spend your downtime. After the surgery, it is important to avoid irritation to the eye area as much as possible and to follow the doctor's instructions. Think of downtime as part of the procedure, take it easy, and make recovery a priority.

If you are worried about the aftereffects of the hamra and back hamra methods, consult Bianca Clinic!

At Bianca Clinic, we value anatomical diagnosis above all else, and offer procedures tailored to the condition and concerns of each individual patient's eye area. Before becoming a cosmetic surgeon, I worked in the plastic surgery department of a university hospital, where I experienced many procedures that focused not only on "appearance" but also on "function and structure," such as eyelid drooping, facial bone fractures, and other surgeries around the eyes, as well as skin sutures. The diagnostic skills based on anatomy and the delicate techniques that require millimeter-level adjustments that I developed there have become a major foundation for my current aesthetic medicine as well.

Our clinic offers a variety of eye area treatments, not limited to the hamula method. During the consultation, we value the viewpoint of "Is the procedure really necessary?" and suggest more suitable options according to your condition and wishes. Therefore, if, as a result of the diagnosis, I determine that the Hamula Method is not the best choice for you, I will not forcefully recommend the procedure. What I value in my practice is to not only conclude that "you should do it," but also to properly inform you of the reasons why you should not do it this time. I believe that such explanation is the sincerity of medical treatment. Even if you are not able to take the first step because of anxiety about aftereffects, please do not be discouraged and come to our office just for a consultation. We will carefully support you by making use of our experience as plastic surgeons so that you can sort out your concerns one by one and choose a procedure that you are satisfied with.

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