Is a transconjunctival blepharoplasty right for my genetic under eye bags? (photos)

Thanks for your pictures. You do have under eye bags which are fat pockets that have herniated. You would do great with transconjunctival lower blepharoplasty, It will significantly improve your look. You may also want to consider some under eye laser resurfacing to further help firm and tighten some of the skin on your lower eyes. Conservative removal would be ideal to prevent future hollowness. Good luck !

Mrs Magellan,Puffy fat can be repositioned safely without an external incision especially in someone your age or the layers that hold the fat in can be tightened to give you a smoother look.  It may be however that you really need some filling beneath the eyelids to improve your cheek/lid junction.Find someone experienced and trust their judgement - you should get a good result.

Some patients do have a genetic predisposition to excess lower eyelid fat accumulation. These patients are excellent candidates for trans conjunctival blepharoplasty.   The correction typically last many years if not a lifetime. If you have a mild tear trough issue, then fillers can complete the job. 

A transconjunctival approach is a very good option for you.  Even at a young age you know that you are unhappy with the appearance of your lower eyelids and the issues from protruding fat, and you realize that it is a problem that is not going to go away.  With that in mind, considering surgery at this stage is appropriate.I prefer transconjuctival approaches for addressing the lower lid fat, especially in a younger patient.For your concern about fat repositioning vs. fat removal without repositioning you really can go either way.  Both are done through a transconjunctival incision.I agree with you that it is imperative for your surgeon to be conservative with fat removal if performing a more classic procedure without fat repositioning.  I think this is a good option though.In cases of a younger patient like yourself, I often will have a long discussion with the patient about being very conservative with the fat removal then planning to possibly come back a few months later and touch things up with some filler in the tear trough area.  That is not always necessary, but it's kind of like the icing on the cake when you have a young attractive patient without much else going on such as loose wrinkled eyelid skin.Fat repositioning is a good option as well.  The argument against it that you have already heard is that the placement of the fat and keeping it there as things heal can be somewhat imprecise and not completely reliable.  However, many surgeons have good consistent results with that technique, and it has the benefit of providing a nice smooth transition from the eyelid to the upper cheek.

There is little reason to be removing fat in a blepharoplasty unless someone has a huge amount of prolapsed fat.  You are correct in your fear of hollowing if fat is removed.  With the amount of fat you have and the hollowing in the tear trough, I would do a fat repositioning.  Once the fat is there is won't move later on. 

The incision for a trans-conjunctival blepharoplasty is inside the eyelid. Extra fat is removed. For older patients, this is often accompanied by a hollow beneath called a tear trough. In that case instead of just removing fat, we transpose part of the extra fat into the hollow. This converts a "hill-valley-hill' appearance to a nice smooth transition of the lower eyelids to the cheeks.

The trans-conjunctival approach to cosmetic lower eyelid blepharoplasty is very favorable. Instead of approaching the fat pads from the outside (trans-cutaneous blepharoplasty) the dissection is actually performed from behind, within the eyelid. The trans-conjunctival blepharoplasty is usually combined with an external skin pinch, to remove the redundant skin, once the fat pads are removed and deflated.Lower lid Blepharoplasty may be performed with a combination of local anesthesia as well as light IV sedation anesthesia. General anesthesia is not necessary, although patient preference should always be taken into consideration.Hope this at least provides useful information. Good luck and best wishes. Dr. Shah

You might be an excellent candidate for fat removal through a transconjunctival approach.  You also may be a good candidate for some tear trough filler to camouflage the region.  Best of luck.

Your concerns are valid but you have missed a subtle point in that your "herniated" fat is not symmetrical and it appears that the lateral compartment of the lower eyelid fat is in a normal position. Depending upon the thickness of your skin and the depth of the groove under the fat you could consider:doing nothing, repositioning the fat below, removing some (careful) excess fat or putting the fat back to it's previous positioning by tightening the septumBest of luckCap Lesesne,MD

When patients  have genetic deposition of fatty deposits in the lower lids at an early age, a trans-conjunctival approach with a conservative fat removal is the best option. this involves making 2 small incisions on the inside of the eyelid. You are correct that too much fat removal can leave the eyelids appearing hollow, but not enough removal results in residual puffy eyes. At age 28, no skin tightening is required from the outside