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 retaining ligaments tethered to the bone. Simply excising this fat resolves the puffiness, but can deepen the tear trough, resulting in a sunken, aged appearance. Fat repositioning involves releasing the tear trough ligament at the inferior orbital rim, mobilizing the vascularized fat pedicle, and draping and securing it over the hollow—effectively turning the excess into a filler. Because the fat retains its blood supply, it does not reabsorb like free fat grafts.
Difference from Fat Removal and Tear Trough Fillers
Compared to fat removal: it preserves volume by redistributing fat rather than excising it, preventing a hollowed look; however, the surgical technique is more complex and swelling lasts slightly longer. Compared to tear trough fillers: it provides long-lasting results without the risks of lumpiness, the Tyndall effect (bluish swelling), or vascular occlusion associated with dermal fillers; nevertheless, it is a surgical procedure with downtime. It is ideal for individuals with both prominent eye bags and deep tear troughs.
Indications
Eye bags accompanied by distinct tear troughs in individuals aged 25–55; hollow orbital rims caused by volume imbalance; patients who have had repeated tear trough filler injections seeking a permanent solution. Surgical approaches: transconjunctival (when skin elasticity is preserved) or transcutaneous subciliary incision (when excess skin excision is required).
Risks to Consider
Swelling and bruising lasting 2–3 weeks (longer than simple fat excision), lumpiness or irregularities at the repositioned site during the initial weeks, minor partial fat atrophy, residual lateral puffiness, temporary lower lid numbness, temporary dry eyes, lower lid malposition/ectropion (with a transcutaneous approach), hematoma, and infection (rare). Most minor irregularities soften and resolve spontaneously within 1–3 months.
At BonBoz
Our plastic surgeons conduct in-person consultations, assessing each fat compartment, measuring the depth of the tear trough, and evaluating skin laxity and eyelid tone to determine the optimal surgical approach. Our surgeons prioritize preserving and repositioning the fat into the tear trough, excising only the true excess, and combining it with skin excision when necessary. The consulting surgeon is the operating surgeon; the longer recovery timeline compared to standard fat removal and the follow-up schedule are thoroughly discussed in advance.
