Transconjunctival Blepharoplasty and Fat Grafting for Hollow Eye Area?

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 circle and rejuvenate the upper cheek-eyelid area.
This is easily done during the surgery. In my experience, the composite graft survives well, does not require repeated injections, and is less likely to create visible lumps as often happens with fat injection.

Thank you for the question. This area is the subject of intense debate in the plastic surgery community over the past few years. The lower eyelid bags are related to the forward movement of the fat that cushions the eye. This is accentuated by fat loss and sagging in the cheek tissues. In many younger patients, conservative reduction of the fat bags is enough to soften the lower eyelid appearance. Unfortunately, this can lead to a hollow appearance or make the tear trough area look worse. Some surgeons treat this issue by placement of fat grafts (generally borrowed from the abdomen). In my practice, I often perform an operation for the lower eyelids that takes care of both of these issues at the same time. This is an extended lower eyelid lift with fat transposition. This operation uses the fat bags that are already present to fill in the tear trough area. If extra skin is present, this can be trimmed as well. If not, the incisions can be made inside the eyelid (transconjunctival). In a very small number of cases, I will add additional fat grafts from elsewhere. This is typically only in patients who are very thin or have had their lower eyelid fat removed in a prior operation. Best of luck moving forward!

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 recommend consulting with a board certified plastic surgeon with experience in this area prior to scheduling any procedures.
Best wishes,
Dr. Bruno