Transconjunctival Lower Blepharoplasty (Lower Eyelid Fat Removal)

Mechanism

Eye bags occur when orbital fat herniates forward through a weakened orbital septum. The transconjunctival approach utilizes a small incision on the inner surface of the lower eyelid, providing direct access to the three fat pads (medial, central, and lateral) without cutting through the skin or the orbicularis oculi muscle. The surgeon either removes the excess protruding fat or transposes it downward to fill the tear trough (fat repositioning). Because the skin-muscle flap remains untouched, the risk of lower eyelid retraction or ectropion is significantly lower than with a transcutaneous approach, leaving no visible external scars.

Who is a good candidate — and who is not?

Good candidates: individuals with pronounced eye bags, good lower eyelid skin elasticity, and minimal wrinkling—typically aged 25–45; those with eye bags accompanied by tear troughs (ideal for fat repositioning); and patients seeking to avoid external scarring. Poor candidates: individuals with excessive skin laxity and pronounced wrinkling. In such cases, removing fat alone eliminates underlying structural support, making wrinkles more prominent; these patients require skin excision (which can be combined via a transconjunctival approach for fat management and a conservative skin-pinch excision).

Fat removal or fat repositioning?

For patients with isolated eye bags and no tear trough deformity: a conservative fat reduction is performed (over-resection leads to a hollowed, aged appearance). For patients with eye bags combined with a deep tear trough: the orbital fat is transposed into the hollow—simultaneously eliminating the bag and smoothing the groove in a single procedure. The surgical strategy is determined during the clinical examination by palpating each fat compartment and assessing the depth of the tear trough.

Potential risks to consider

Swelling and bruising for 1–2 weeks, subconjunctival hemorrhage (redness in the sclera) lasting a few weeks, temporary dry eyes, asymmetry or residual fullness in the lateral fat pad, over-resection causing a hollowed appearance, retrobulbar hematoma (extremely rare, medical emergency), and infection (rare). Because this technique does not address excess skin, patients with loose skin may notice more apparent fine lines post-operatively.

At BonBoz

Our plastic surgery specialists personally conduct thorough evaluations, assessing the exact position and volume of each fat pad, skin elasticity, tear trough depth, and lower lid tone. For patients with good skin tone, the surgeon will select the transconjunctival approach and determine whether conservative excision or fat repositioning is optimal. For patients with excess skin, the necessity of skin excision and available surgical options will be clearly explained. The consulting specialist is the operating surgeon; expected swelling duration, scleral redness, and follow-up schedules are thoroughly detailed in advance.