Would a transconjunctival approach be recommended? Would I need fat repositioning? (Photos)

Question

i am considering lower eyelid surgery and wondering if based on my skin, a transconjunctival approach approach woudl be appropriate? I don't think (?) i have a ton of fat under my eyes... i do have hollows. Would i need fat repositioning? I'm of course getting an in-person consulation but just wondering based on the photos, if that would be the recommendation

Julian De Silva, MD · Answer

Hi Witty239770, this is a thoughtful question and you are asking exactly the right things before your consultation. From your description and photos, two points may help.

First, the transconjunctival approach, through the inside of the lower lid, is generally suited to people whose skin quality is good and whose main concern is the fat compartments rather than excess skin. It leaves no visible scar and does not disturb the muscle that supports the lid.

Second, and more important in your case: you describe hollows rather than prominent fat bags. When hollowing is part of the picture, simply removing fat tends to age the eye rather than refresh it. The modern approach is conservative: preserve the fat and reposition it over the hollow, or add small amounts of your own fat, so the transition between lid and cheek becomes smooth. As an oculoplastic-trained surgeon I spend more time deciding what to keep than what to remove in these cases.

Whether repositioning is right for you depends on how much true hollowing versus fat prominence there is, which needs the in-person examination you already have planned. Good luck with your consultation.

Would a transconjunctival approach be recommended? Would I need fat repositioning? (Photos)

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