Less Invasive Eyelid Procedure to Remove Fatty Tissue?

I have a layer of white fatty tissues bulging out of my eyelash bed underneath both eyes.

At the moment, it is mostly hidden behind my eyelashes but a line has formed underneath each eye below the fat bulges. I would like to correct this and pre-empt any further deterioration.

What treatments are suitable as I feel a full lower lid Blephroplasty may be overkill?

Doctor Answers 8

Conservative treatments for fatty tissue in lower eyelids

The most conservative treatment directed towards reducing the fat pads on the lower lids are to make sure that your thyroid hormones are within normal range and that you do not have thyroid disease. In addition, make sure any allergies are well-controlled and you are on a low-salt diet. Fatty tissues underneath the eyelids do tend to retain fluid and are made worse with allergies and salt intake. If all of the above are within normal limits, the only other alternative is makeup. A surgical alternative is to do a transconjunctival blepharoplasty, which is an incision placed on the inside of the eyelid to remove the three little fat pads creating the puffiness and the double bubble effect.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Correcting eyelid bulges

What you described could be small eyelid cysts as you mentioned they are just under the eyelashes.

Fat pockets typically are lower down from the lash line than what you described. In either case, this will not be likely to resolve without a procedure. You need to be examined by a surgeon who will recommend the best approach.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.7 out of 5 stars 34 reviews

White fatty tissue of lower eyelid

If you have small pockets of white fat on top of your skin, then this is Xanthelesmas which can easily be unroofed and the fat removed. If you have fatty bulges underneath the skin that are kind of showing through as a bulge, then a transconjunctival fat excision through the inner aspect of the eyelid hidden , would be a good way to go.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Fat Bulges under Eyes Need Rhinoplasty

Your lower eyelid fat needs to be removed. That is only accomplished through Blepharoplasty.

Some newer methods involved sticking in a laser fiber and burning the fat. However, the safest method is to do a traditional blepharoplasty by either a transcutaneous approach (making a cut just below eyelashes) or transconjunctival (from inside the lower eyelid) and then cutting out the fat.

There is no way to prevent these bulges. Usually its hereditary. Sometimes good skin care on lower eyelids like toners, healthy living can delay the process a littel bit.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 105 reviews

Transpinch lipectomy

The transconjunctival approach is effective and leaves no external incision but the incision on the back of the eyelid can be quite irritating for a week or so. It also, in and of itself, does not allow for removal of extra skin. I have developed a technique in which the skin just below the lashes is pinched and removed and the fat is then removed using this incision through small tunnels. I have found this approach to be the least invasive way of performing a lower eyelid, less invasive than a tranconjunctival approach and definitely less invasive than the skin muscle flap approach.

Min S. Ahn, MD, FACS
Westborough Facial Plastic Surgeon
4.6 out of 5 stars 35 reviews

A less invasive procedure for under eye fullness

When all you have is puffiness around the eye, but no sagging, it's possible to reduce the puffiness without scars and with almost no downtime, using a subconjunctival blepharoplasty. With this procedure, fat is excised from inside the eyelid. Since the incision is out of sight the recovery is quicker then traditional eyelid surgery and if you have a little bruising it can easily be concealed with makeup. This prodecure heals in a week, and is a great quick fix.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

It may be xanthelasma.

A picture of your eyelids would really be helpful here, but what you're describing sounds a lot like a condition known as xanthelasma. Xanthelasma is not corrected with a lower blepharoplasty, but the unsightly blobs can often be easily treated in the office.

The important point, though, is that a significant portion of patients (about 1/3) with xanthelasma also have an underlying lipid disorder such as high cholesterol, high triglycerides, etc. Make sure that you have this properly diagnosed first.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Is it excess muscle or fat on lower eye area?

Dear Jedder,

Please post photos! It's hard to make an assessment without seeing pictures.

The big question in my mind is whether this bulge represents fat or excess muscle. If the protuberance is fat, the only good solution is lower eyelid blepharoplasty.

However, if the bulge is a roll of muscle, then you have options:

  • A lower eyelid blepharoplasty might still be the answer. It is a power operation for contouring excess fat, muscle, and skin.
  • Botox can minimize excessive orbicularis oculi muscle without surgery.

Regarding Botox, you should find an experienced Botox injector. Ask for 1 unit of Botox in the roll under each eyelid. Wait a few weeks. Then, assess the result. You just might be able to solve your problem without surgery.

(If your plastic surgeon is up on the latest treatments, 2.5 units of Dysport would also work. Dysport is nearly equivalent to Botox.)

Do be aware that this is a tricky use of Botox/Dysport. There are a few potential (albeit unlikely) risks.

  • Lowering the lower eyelid margin (so that you see white beneath your irises--the colored portion of the eye)
  • Loosening the tension on the fat beneath the eyes, such that real fat bags do become apparent
  • Causing your eyes to become dry and scratchy

I highly doubt that you will have problems, but other plastic surgeons might be hesitant to give my suggestion a try. This is definitely a Botox/Dysport use for experienced injectors only.

(By the way, Angelina Jolie also has muscular rolls beneath her lower eyelids. You're in good company.)

Michael C. Pickart, MD
Ventura Plastic Surgeon
5.0 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.