Transconjunctival Blepharoplasty and Fat Grafting for Hollow Eye Area?

I am a 50 year old Asian. Have consulted a plastic surgery regarding removal of eye bag. He recommends me to do a transconjunctival eyelid surgery (incision inside) because there is not much excess skin to remove. In addition, he suggested a fat transfer to correct hollow sunken eye area after removing the eye bag.

Is internal incision eye bag surgery a better option compared with external incision and is recovery is much faster? Does it also make sense to transfer fat immediately after the surgery to correct hollow and sunken eye?

Your input is appreciated.

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Transconjunctival approach is the best approach for fat removal.

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.

Lower eyelid surgery

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

Transconjunctival blepharoplasty with immediate composite fat grafting is your best option

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

Transconjunctival Blepharoplasty with fat grafting can be an excellent procedure

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

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.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Reasonable approach for hollow eye area

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

Transconjunctival blepharoplasty and fat injection to lower eyelids

This solution may not be as silly as it sounds on first blush. The bulge of fat is due to a bulge in the infraorbital fat behind the orbital septum. Transconjunctival blepharoplasty removes the fat, causing it to bulge less. The hollowness most patients complain of is lower than the infraorbital fat bulge. There are two basic solutions to this problem: 1. Take the existing fat and redistribute it. This requires dividing the orbital septum at the arcus marginalis, a maneuver that can... more

Need pictures to determine for sure

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.

Anatomical analysis

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

Robin T.W. Yuan, MD

4 reviews

Beverly Hills Plastic Surgeon

Eye lid fat can be utilized for correction

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