Transconjunctival Blepharoplasty and Fat Grafting for Hollow Eye Area?

The treatment of your lower eyelids depends on the anatomic abnormality. Often times patients will describe "bags" under their eyes, which can be many different things. The fat may be removed very conservatively, but what may be more critical, is to reposition the fat so as to regain a smooth lower eyelid to cheek transition. A photo would be very helpful to help diagnose your condition and render a reasonable treatment plan. This area of the face is very unforgiving, and I... more

A transconjunctival blepharoplasty is the best way to remove orbital fat that is creating a bulge in the lower lid. Fat transfer into the sunken area also works quite well and can be performed better through a transconjunctival approach. It is not a good idea to have the external approach because the muscle is transected, becomes weaker and can pull down changing the shape of the eye, giving some scleral show.

Your surgeon is correct. The transconjunctival blepharoplasty avoids a visible blepharoplasty incision and more importantly preserves eyelid shape. Traditional external incision blepharoplasty can injure the support of the lower eyelid and result in a sad eyed look or hound dog eyes. I prefer open composite fat grafting to fat injection. During the transconjunctival blepharoplasty I graft the excess fat that has been removed into the lower area beneath the lower eyelid to plump the dark... more

The bulge of excess fat creating the "bag" under the eye is reduced nicely by transconjunctival resection. If there is not a lot of excess skin, then there is no reason to perform an external incision and incur the slight increase in risk. Along with the fatty bulge, people often have a crease or "tear trough" under the eye along the bone, and placing harvested fat in this crease can fill it and create a very smooth line from the eyelid to the cheek when combined with... more

Transconjunctival fat removal and redraping is certainly an acceptable surgical modality for your situation based upon what you wrote in your question.  External or internal approach is fine.

It seems very reasonable based on your description to decrease the excess fat that causes bulging of the lower lid. This can be approached either from inside the eyelid of through an incision on the outside. Most skilled, experienced Plastic Surgeons would be comfortable with both approaches. An adjuvant to the procedure would be utilization of the removed fat to help fill in the tear trough (nasojugal fold) or the deep fold that sits below the bulge. This can be done via a variety of... more

It is always better to avoid external incisions when possible. I have been doing the transconjunctival procedure for 25 years and prefer it to other approaches. Usually conservative removal of fat is performed so it is rare to add fat in this situation. If a hollow trough is present below the prolapsed fat it is preferable to transpose or move the fat into the deformity rather than removing it.

Your question is not specific enough to render a recommendation. Sunken eye, hollow eye, and bags are not anatomical terminology. They are descriptive. A surgeon would have to determine what the hollowness is due to, why an eye looks sunken, and what makes the bag. There are variations in bone, muscle, fat that make all of our eyes different. A bag can be caused by excess fat, loose skin, reactive edema, underdeveloped orbital bone, pigmentation, etc. What makes sense surgical is dependent... more

The transconjunctival blepharoplasty sounds like the right approach for you but I would suggest moving the fat to the hollow areas and not removing any. The fat is essentially stuck in a particular compartment that makes it look like there is too much. However, just on the other side of the fat compartment is an area that needs the fat. With the proper technique, the fat compartment can be opened and the fat can be distributed into the hollow area. Best Wishes Dr. Peterson... more

Dear Pepys It is impossible to know your issue without a personal consultation. However, in general it is always much safer for you to have lower eyelid surgery from behind the lower eyelid transconjunctivally. Then the fat is removed from the lower eyelid using a skin incision, the surgery uniformly damages the nerves that supply the lower eyelid muscle responsible for holding the lower eyelid firmly against the eye. Additionally the scar tissues that develop following this surgery plus any... more

It does not make any sense at all. When we do transconjunctival blepharoplasty, it is usually done to remove the excess fat. Why would you take out fat and then immediately put it back in? Regards