In short. Transconjunctival eyebag surgery removes or repositions under-eye fat through an incision on the inside of the lower eyelid. It suits a soft fat bag with firm skin, whereas loose or crepey skin needs the external transcutaneous route, which can remove skin. The internal cut heals without a visible external scar, but it cannot tighten the surface.
Key points
- The incision sits inside the lower lid, so no external scar is visible.
- It suits a fat bag with firm skin, not loose or crepey skin.
- Fat is removed conservatively or repositioned to avoid a hollow eye.
- The route cannot remove skin or correct surface wrinkles on its own.
- Lid tone is assessed first because weakness risks a position change.
What is transconjunctival eyebag surgery?
Transconjunctival eyebag surgery removes or repositions under-eye fat through an incision on the inside of the lower eyelid. Because the cut is hidden against the eye, there is no visible external scar, which is why the approach is often described as leaving no scar at all. The internal incision still heals, and it is closed with fine dissolving stitches that usually need no removal. The skin surface itself is left untouched.
Who is it for, and who is it not for?
The method is designed for patients whose main concern is a true fat bag: a soft, often inherited bulge under the eye, with reasonably good skin tone. It is not a treatment for loose or crepey skin, or for a lower lid that is itself weak. In those cases removing fat alone will not tighten the surface, and a combined or external plan may be better.
Internal versus external: the dividing line
The choice follows the tissue, not preference. A prominent fat bag with firm skin suits the internal route. Genuine skin excess, a visible roll of muscle beneath the lashes, or a need to tighten and support the lower lid call for the external route, because the transconjunctival approach cannot tighten the skin surface. Many patients benefit from a combination of the two.
| Internal (transconjunctival) | External (transcutaneous) | |
|---|---|---|
| Incision | Inside the lower eyelid | A fine line just below the lashes |
| Suits | A soft fat bag with firm skin tone | Loose or crepey skin, a muscle roll, or a weak lower lid |
| Skin removal | Not possible through this route | Excess skin can be removed |
| Visible scar | None on the skin surface | A fine line below the lashes that does not disappear |
| Main risks | Bruising, temporary swelling, asymmetry; uncommonly a change in lid position | Visible scarring and lid malposition |
What happens during the operation
Through the inner lid the surgeon opens the fat compartments that bulge forward, removes a conservative amount, and sometimes repositions fat over the cheek groove to smooth the lid to cheek junction. The incision is then closed with fine dissolving stitches.
A conservative principle governs the amount removed. Taking too much lower lid fat can hollow the eye and age the face. Modern practice favours removing or repositioning only enough to flatten the bag while preserving a natural, rested contour.
Recovery after an internal approach
Because there is no external incision, surface healing is quick. Swelling and bruising still occur, and are usually most obvious for the first week to ten days, settling over two to three weeks. Most people feel socially comfortable within two weeks. The internal stitches dissolve on their own.
Limitations and risks
The approach does not remove loose skin, so it will not correct surface wrinkles or crepey texture on its own. Risks include bruising, temporary swelling, asymmetry and, uncommonly, a change in lid position if support is weak. That is why a careful assessment of lid tone is essential before choosing this route.
When should you seek review?
Contact the clinic promptly if vision changes, if pain or swelling increases rapidly on one side, if the eye cannot close, if the lid position looks suddenly wrong, or if signs of infection appear.
Sources
Internal links
Frequently asked questions
Is transconjunctival eyebag surgery really scarless?
There is no visible external scar because the incision is made on the inside of the lower eyelid, but the internal cut still heals. It is closed with fine dissolving stitches that usually need no removal. The skin surface itself is left untouched.
Will this also remove the wrinkles under my eyes?
It does not remove loose skin, so surface wrinkles and crepey texture are not corrected on their own. If the skin is loose or the lower lid is weak, removing fat alone will not tighten the surface and a combined or external plan is usually better.
How much fat is actually removed?
Only a conservative amount. Removing too much lower lid fat can hollow the eye and age the face, so modern practice favours removing or repositioning just enough to flatten the bag while preserving a natural, rested contour.
Risks & Limitations
- Dry eye, watering or a gritty sensation, which may be temporary or lasting.
- Difficulty closing the eye fully (lagophthalmos); if it persists it can expose the cornea and needs review.
- Asymmetry, an uneven crease, or under- and over-correction, which may require revision.
- Bruising and swelling that can take several weeks to settle.
- Visible or thickened scarring; scars are permanent but mature and fade over 6–12 months.
- Altered or reduced sensation around the lid, usually temporary but occasionally lasting.
When to Seek Care
- Any sudden change in vision, loss of vision, or double vision — seek emergency care immediately.
- Severe pain, or an eye that becomes tense, hard and swollen.
- Inability to close the eye, or new redness and pain in the eye itself.
- Spreading redness, warmth, pus or fever above 38 °C.
- Bleeding from the wound that does not stop with gentle pressure.
References & Further Reading
- American Academy of Ophthalmology (AAO) — public eye health information
- American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS)
- American Society of Plastic Surgeons (ASPS) — procedure guidance
- Cochrane Library — systematic reviews in oculoplastic surgery
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.