Under-Eye Fat Repositioning

Clinical Overview & Guide

Under-Eye Fat Repositioning is a structural lower eyelid procedure that corrects protruding orbital fat pads ("eye bags") and the adjacent sunken tear trough groove—the primary anatomical cause of shadowed dark circles and a chronically tired expression. Simply excising large amounts of lower eyelid fat can lead to a hollowed, aged appearance over time. Instead, repositioning transfers the herniated fat across the released tear trough ligament to fill the depressed groove, creating a smooth transition from the lower eyelid to the upper cheek.

At IBON Plastic Surgery, Dr. Ju-Chan Kim (Board-Certified Plastic Surgeon) evaluates compartment-specific orbital fat protrusion, tear trough ligament tethering, and lower eyelid skin elasticity to select the optimal lower eyelid approach.

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Comparison of Lower Eyelid Procedures

Depending on skin laxity and the degree of fat herniation, the procedure is tailored among three specialized techniques:

Procedure	Surgical Approach & Mechanism	Ideal Candidates
Transconjunctival Under-Eye Fat Repositioning	Makes a micro-incision inside the lower conjunctiva to release the tear trough ligament and transpose protruding fat into the depressed groove	Patients in their 20s to 40s+ with under-eye bags and tear trough shadows but good lower eyelid skin elasticity
Transconjunctival Lower Blepharoplasty	Uses an internal conjunctival approach to conservatively contour excess orbital fat and reinforce the orbital septum	Patients with prominent fat bulging and firm skin without significant skin redundancy
Incisional Lower Blepharoplasty	Places a subciliary incision just beneath the lower lashes to reposition fat while tightening lax skin and orbicularis muscle	Middle-aged and older patients presenting with both under-eye fat protrusion and loose, wrinkled lower eyelid skin

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Core Surgical Principles & Clinical Advantages

• Scarless Internal Conjunctival Access: Both Under-Eye Fat Repositioning and Transconjunctival Lower Blepharoplasty are performed through the inner conjunctival surface, leaving no visible external skin scar and preserving the natural pretarsal orbicularis roll (aegyo-sal).
• Tear Trough Ligament Release & Septal Reinforcement: Complete release of the tethered osteocutaneous tear trough ligament allows the transposed fat pedicle to lie flat without recurrence, while septal reinforcement supports long-term contour stability.
• Clinical Guides & References: For a deeper explanation of the surgical anatomy, read our clinical article on How Under-Eye Fat Repositioning Works and our feature on Why Lower Eyelid Fat Repositioning Is Popular. Clinical protocols adhere to standards from the Korean Society of Plastic and Reconstructive Surgeons (KSPRS) and the Archives of Craniofacial Surgery (ACFS).

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Surgical & Recovery Overview

• Procedure Time: Approximately 40 to 60 minutes
• Anesthesia: Local anesthesia with short-acting intravenous sedation
• Suture Removal: No external suture removal required for transconjunctival approaches (days 5–7 if combined with subciliary skin excision)
• Recovery Timeline: Mild swelling or bruising under the eyes typically peaks within 3 to 5 days and resolves enough for comfortable social activities within 1 to 2 weeks. To find out whether transconjunctival repositioning or Lower Blepharoplasty is best for your eyes, book a 1:1 Online Consultation.

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Frequently Asked Questions (FAQ)

Q. Does Under-Eye Fat Repositioning completely eliminate dark circles?
A. Dark circles generally stem from three factors: (1) structural shadowing caused by bulging fat above a sunken tear trough, (2) vascular visibility through thin skin, and (3) superficial melanin pigmentation. Under-eye fat repositioning directly corrects structural shadowing, flattening the bulge-and-groove contour so light reflects evenly across the lower eyelid and brightens the overall impression.

Q. Will my natural under-eye roll (aegyo-sal) disappear after surgery?
A. No. The pretarsal roll (aegyo-sal) is formed by the superficial orbicularis oculi muscle immediately below the eyelashes, whereas under-eye fat repositioning addresses the deeper orbital fat pads lower down. In fact, removing the bulging shadow beneath the pretarsal muscle often makes your natural aegyo-sal look cleaner and more defined.