Aegyo sal surgery: cute Korean puffy eyes (애교살)

Aegyo sal refers to a popular cosmetic surgery procedure performed in South Korea. This has become a trending aesthetic procedure thanks to K-Pop stars and idols in South Korea, but the popularity quickly spread to Thailand, China, Taiwan and Japan where it is commonly performed, as well as to the rest of the world.

aegyo sal puffy and lovely korean eyes surgical procedure

What is Aegyo Sal?

Aegyo sal consists in the small roll of tissue made by a tiny pocket of fat plus the muscle above it that sits right under the eye. It is said to give the eyes a younger look, since this facial feature is common in the early years of life; it is regarded as a very attractive feature that gives the eyes a smiling look, contributing to an overall young and adorable face, but it is also said to provide at the same time both an innocent and teasing/flirting attribute to the eyes.

Medically speaking, it is known as the orbicularis roll, from the name of the muscle that contributes to its volume which is the orbicularis oculi muscle.

What does Aegyo Sal mean? (애교살)

Aegyo Sal (애교살) in Korean roughly means “lovely fat” while in Chinese it is called Wò cán (卧蚕) which translates into “lying worm” and in English it is called “(eye) love bands”.

Although “lovely” or “charming fat” is the literal translation in English, when Koreans say Aegyo Sal they use it to refer to a very specific anatomical region, the tiny fat and muscle roll right under the eye where the namesake procedure is performed, hence it cannot be used to refer for example to nice round buttocks.

Is Aegyo Sal an eye bag augmentation?

It is important to note that Aegyo Sal is not an “eye bag augmentation”: eye bags are located low under the eyes and cover a larger area, while aegyo sal refers to the augmentation of a small area located right under the eye and above were you would normally find the eye bags. Moreover, while eyebags are unappealing, the Aegyo Sal is sought after.

Here are the main differences between eye bags and aegyo-sal:

  1. Location. The aegyo sal sits right under the eye, while the eye bag is located below the aegyo sal.
  2. Size and shape. The aegyo sal is worm/sausage shaped, small and puffy, while the eye bag covers a large area and looks diffusely swollen rather than puffy.
  3. Color. The aegyo sal may have a lighter skin color when compared to the surrounding skin, brightening the under-eye area, or have the same color while eye bags have a darker color than the surrounding skin.
  4. Overall effect. The aegyo sal gives a young, smiling and innocent yet flirty and lovely look, while the eye bags give an old, sad and tired look.

5 methods to get aegyo sal

There are several invasive, minimally invasive and non-invasive techniques, temporary or permanent, to create the illusion of an Aegyo Sal or to create it surgically. The main methods are:

  1. Make-up
  2. Cosmetic Tape
  3. Dermal Fillers
  4. Fat graft
  5. Acellular tissue matrix graft (AlloDerm, DermaMatrix)

Make-up for Aegyo Sal

Make-up can help provide the illusion of an aegyo-sal and is a quick, simple and cheap alternative to medical procedures; to try it out, you should be in front of a mirror with good lighting:

  1. Smile like you really mean it. A fake smile mostly uses the mid-lower face muscles, while a real smile involves the eyes as well (ie. Douchenne smile); by doing this you should be able to see where your natural aegyo sal is located:
  2. now you should first use a liner to trace the contour,
  3. then put a shadow right under it,
  4. while highlighting the upper part.
  5. Finally blend everything out for a natural appearance.

The pros with make-up are that you can experiment many different techniques, shades, tools and enjoy a wide range of results; moreover, it has no side effects or potential complications, it is cheap and quick to do. The cons of makeup are that it’s not really like the real thing and it’s temporary, so it requires reapplication every time you want it.

Cosmetic Tape for Aegyo Sal


Cosmetic tape is another safe, cheap and quick method to create the illusion of an aegyo sal, but it’s just temporary and can fail and fall off while using it. It consists of an invisible adhesive tape that you can use to create a bulge and that is also commonly used to create the illusion of a double eyelid.

Dermal fillers for Aegyo Sal

This method involves injecting a dermal filler to enhance the volume right under the eye and create the aegyo sal. Hyaluronic acid fillers are commonly used for this procedure, such as Restylane and Juvederm.

It is almost painless and may just cause some minor bruising at the injection site. It is a temporary treatment, so you may have to book an appointment with your surgeon every 6 months for a touch-up.

Fat grafting for Aegyo Sal

Fat grafting is a surgical procedure performed by harvesting fat through liposuction from a viable donor area, processing it, and reinjecting it into the body in the area that needs to be augmented. Some of the reinjected fat cells will not survive the transplant and on average only about 70% of grafted fat will actually stay in place with a reduction from the original volume injected; the surgeon will slightly overfill the area taking into account that within a few weeks some volume will disappear.

The augmentation obtained with fat grafting is virtually permanent and should last for many years, although results may vary depending on each individual metabolism.

Acellular tissue matrix for aegyo sal

The acellular dermal matrix (ADM) is a soft connective tissue graft obtained from human or animal tissues with all cells removed leaving only the surrounding structure intact. It is safe, being screened for diseases and sterile, and won’t cause rejection by the immune system. It basically serves as scaffolding for our own cells and is commonly used to support and reinforce weakened tissues in many different surgical specialties.

An acellular dermal matrix such as AlloDerm or DermaMatrix can also be used to create the aegyo sal, and will lead to a permanent result because this type of grafted structure can’t be resorbed by our body.

The use of the ADM requires local anesthesia and a small incision to access the area, plus a couple of internal stitches to fix the dermal matrix in position. If executed properly and with no complications while healing it should leave no scar.

Which method is the best?

In my humble opinion, leaving aside non-medical methods, using hyaluronic acid fillers would be my first choice for many reasons: if done properly it has almost no risks, downtime and side effects are minimal, it is reversible with hyaluronidase and temporary because it is resorbed in about 6 months. After trying with hyaluronic acid and liking the result, I would go for a fat graft for a longer lasting solution.

I would not advise the use of permanent fillers or ADM because they are permanent, and it would be impossible to revert the results. In a delicate area like under the eye, trying to remove or fix a permanent filler injection would mean leaving behind marks and scarring. Moreover, with aging our face changes considerably: skin, fat, muscle and bone tissue become atrophic, but the permanent filler won’t change, potentially leading to unappealing looks. Permanent filler are made of non-biological materials (alloplastic materials) which our bodies cannot break down: this may sometimes cause the formation of lumps or cause chronic inflammation do to an immune reaction to foreign material. A mistake made by the injector, miscommunication between patient and doctor, unclear expectations are some of the other possible ways in which something could go wrong; remember that even the world’s best surgeon can make a mistake, we are all human, we can just minimize the risks and not using a permanent filler is one of the ways to minimize the aegyo sal’s risks.

Cost of aegyo sal procedures

It is very important to have a consultation with an experienced and qualified oculoplastic surgeon or plastic surgeon with knowledge and experience in this specific procedure. While one may be easy to find in places like South Korea or Thailand, in Europe or America this could prove to be difficult, so do your own research!

The price for Aegyo Sal would be around 1,000 USD when done using hyaluronic acid fillers in Europe or North America, and over 2,500 USD for fat grafting.

In Thailand, prices for the Aegyo Sal would start around 4,000 THB for Neuramis (Korean HA Filler – 1 cc) or 10,000 THB for 1 cc of Juvederm, and around 30,000 THB for the fat grafting procedure.

In South Korea, the cost of Aegyo Sal starts around 150 USD for Neuramis or 400 USD for Juvederm/Restylane, while fat grafting will start around 1,000 USD.



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