That method — transconjunctival fat repositioning — is designed for a particular type of under-eye concern. It is usually considered for people whose concern is bulging or shadowing and whose skin is still elastic, which in Dr. Lee's experience is most often the case in the 20s and 30s. When the main problem is loose skin or other changes, the inside approach alone may not be enough, and this is explained at consultation.
Greetings from SM Plastic Surgery in Gangnam, Seoul. Online, under-eye surgery from inside the eyelid is often described mainly in terms of scarring. We prefer to describe it by method: the surgeon works through the inside of the lower eyelid, so there is no incision in the skin of the lower lid.
That method — transconjunctival fat repositioning — is designed for a particular type of under-eye concern. It is usually considered for people whose concern is bulging or shadowing and whose skin is still elastic, which in Dr. Lee's experience is most often the case in the 20s and 30s. When the main problem is loose skin or other changes, the inside approach alone may not be enough, and this is explained at consultation.
What is transconjunctival fat repositioning?
Under-eye bags often come from fat that pushes forward, with a hollow groove just below it. Fat repositioning moves that fat into the groove instead of removing it, aiming to smooth the transition between the two; how much this changes the look differs from person to person. The technique traces back to the Hamra method, published by Dr. Sam T. Hamra in 1995.
In the transconjunctival version, the surgeon works through the inner surface of the lower eyelid (the conjunctiva). SM Plastic Surgery offers four under-eye procedures under the names it uses in Korea: the Hamra method, the transconjunctival Hamra method, lower blepharoplasty with a skin incision just below the lash line (subciliary approach), and under-eye fat repositioning. In English, "lower blepharoplasty" is a broad term that includes both skin-incision and transconjunctival approaches, so it helps to ask any clinic which approach it means. Having several options allows the method to be chosen to suit the eyelid.
Who is it usually right for?
At the clinic, the inside approach is considered most suitable when skin elasticity is good and the concern is bulging, shadowing or a dark-circle look — most often in people in their 20s and 30s. When skin elasticity has decreased, which is more common from the 40s onward, lower blepharoplasty with a skin incision is often considered alongside it. Age is a guide; the deciding factors are your skin, muscle and fat.
Recovery differs by method too. According to Dr. Lee's guidance, after under-eye fat repositioning most patients return to daily life in about 3 days and the main swelling settles in about 3 days; after lower blepharoplasty with a skin incision, both take about 7 days. These are approximate, and some people need longer.
In which situations may the inside approach need another technique?
Dr. Lee Moo-young lists five situations where transconjunctival fat repositioning on its own has limits, and where lower blepharoplasty may need to be combined:
| Situation | Why the inside approach is limited |
|---|---|
| 1. Loose skin | Moving fat does not tighten skin that has stretched |
| 2. Weakened eyelid muscle (orbicularis oculi) | Muscle laxity is not corrected from the inside |
| 3. Not enough fat to move | Fat grafting (your own fat) may need to be added |
| 4. Midface volume loss | The hollow extends beyond the under-eye area |
| 5. Pigmentation | Skin pigmentation is not caused by fat position |
If you recognise yourself in one of these rows, it does not mean you cannot be treated. It means the plan may involve more than one technique, and that is worth knowing before you book a short trip.
Do patients from different countries choose differently?
In Dr. Lee's own experience at the clinic, Korean patients more often choose the skin-incision approach and Japanese patients the approach without a skin incision. This is an observation about preference, not a medical rule. In his experience, the skin-incision approach usually involves longer swelling and bruising, while recovery without a skin incision is often quicker, though this also depends on what else is done. A preference is a starting point; the final choice depends on your skin, muscle and fat.
Frequently asked questions
Q1) Does transconjunctival fat repositioning leave a scar on the skin?
A1) The incision is made on the inner surface of the eyelid, so there is no incision in the skin of the lower lid. Healing still differs between individuals, and the risks are explained at consultation.
Q2) I am in my 40s. Can I still have the inside approach?
A2) It depends on your skin and the other factors above. When elasticity has decreased, lower blepharoplasty is often considered alongside it. This is decided at examination.
Q3) How long should I stay in Seoul?
A3) As a guide from Dr. Lee, return to daily life takes about 3 days after fat repositioning and about 7 days after lower blepharoplasty with a skin incision, with individual differences. Your stay also needs to cover any follow-up visit, so discuss your travel dates at consultation before booking.
Q4) Who performs the surgery?
A4) Dr. Lee Moo-young, a plastic surgery specialist certified in Korea, handles your care directly from consultation to surgery.
Results and recovery differ between individuals. Please make decisions after a full consultation with a plastic surgery specialist.
Lower eyelid fat repositioning can cause swelling, bruising, bleeding, and infection, and the under-eye area may look uneven, or bulging or hollowness may remain or recur. Dry eyes or a foreign-body sensation, swelling of the conjunctiva, and asymmetry may occur, and rare complications such as bleeding around the eye or blood vessel injury are possible. Skin laxity, a weakened orbicularis muscle, insufficient fat volume, midface hollowing, or pigmentation may limit improvement, and another procedure may need to be combined. Recovery speed and results vary from person to person.