Lower Blepharoplasty with Fat Repositioning

Mechanism

In aging or structurally predisposed lower eyelids, orbital fat herniates forward to create eye bags, while directly below lies a hollow tear trough caused by soft tissue atrophy and a retaining ligament firmly anchored to the bone. Traditional fat excision alone removes the bags but can deepen the hollow, resulting in a sunken, aged appearance. Fat repositioning involves releasing the tear trough ligament along the infraorbital rim, mobilizing the pedicled fat (with its intact blood supply) downward to fill the hollow, and securing it in place—effectively turning excess into volume replacement. Because the fat retains its vascular pedicle, it does not reabsorb like free fat grafts.

Difference from Fat Excision and Tear Trough Fillers

Compared to traditional fat excision: it preserves volume by transposing fat rather than discarding it, preventing a hollowed-out look; however, the technique is more complex, with slightly longer swelling. Compared to tear trough fillers: it delivers long-lasting results without the risks of lumpiness, the Tyndall effect (bluish discoloration), or vascular occlusion associated with dermal fillers; nevertheless, it is a surgical procedure with downtime. It is best suited for individuals who have both under-eye bags and prominent tear troughs.

Indications

Under-eye bags combined with distinct tear troughs in individuals aged 25–55; hollowed eye sockets due to volume imbalance; and patients who have had repeated tear trough filler injections and desire a permanent solution. Surgical approach: transconjunctival (when skin elasticity is good) or transcutaneous subciliary (under the lash line when excess skin needs to be excised).

Risks to Know

Swelling and bruising for 2–3 weeks (longer than simple fat excision), temporary contour irregularities or firmness in the repositioned area during the initial weeks, minor fat reabsorption, residual lateral bags, temporary eyelid numbness, transient dry eyes, eyelid retraction/ectropion (with a transcutaneous approach), hematoma, and infection (rare). Most minor irregularities soften naturally within 1–3 months.

At BonBoz

A board-certified plastic surgeon conducts a direct clinical examination, palpating each fat compartment, measuring the depth of the tear trough, and assessing skin laxity and eyelid tone to select the optimal surgical approach. The surgeon prioritizes preserving and transposing fat into the hollow, excising only the true excess, and combining skin excision when necessary. The consulting surgeon is the operating surgeon; the extended recovery timeline compared to standard fat removal and the follow-up schedule are thoroughly discussed in advance.