I get why they insist on fat removal. It feels like my perception of repositioning has changed somehow. I had a lot of concerns about the skin under my eyes, so I went for a consultation at a place recommended for its skill, and came away being recommended removal rather than repositioning. It seems like it can be done permanently without scars, unlike repositioning, so I even booked the surgery. And because the surgery goes in through an incision inside the conjunctiva, the fact that incision and hemostasis happen at the same time seemed like a plus.
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