Modified Lower Blepharoplasty with Fat Repositioning via Transconjunctival Approach to Correct Tear Trough Deformity



Over the years, many techniques have been described to correct tear trough deformity (TTD). Fat-repositioning lower blepharoplasty via a transconjunctival approach is increasingly applied due to its satisfactory rejuvenating effect. However, those methods have disadvantages such as a complicated surgical approach, residual scar, and long recovery time.


We modified the surgical technique of fat-repositioning transconjunctival lower blepharoplasty with an effective but easy internal fixation method via a supraperiosteal approach.


From January 2014 to December 2017, 110 patients underwent bilateral modified lower blepharoplasty with fat-repositioning. Preoperatively, the grade of TTD was evaluated according to Barton’s grading system. Postoperative results and complications were assessed during the follow-up period.


TTD was ameliorated in 97.73% of the cases; the remaining 2.27% cases with no improvement underwent revision and achieved Grade 0 on Barton’s grading system thereafter. All patients were satisfied with the final outcome. Few postoperative complications were observed, none of which led to a permanent condition. Three cases of local depression and one case of local bulge were treated with surgical refinements. One case of postoperative hemorrhage was healed by electrocautery.


Our modified method of transconjunctival lower blepharoplasty with fat repositioning is safe and effective to improve TTD without severe orbital skin laxity.

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Correspondence to Feng Xie or Qingfeng Li.

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Ethical approval was given by the ethics committee at our institution and written informed consent was obtained from all patients.

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Duan, R., Wu, M., Tremp, M. et al. Modified Lower Blepharoplasty with Fat Repositioning via Transconjunctival Approach to Correct Tear Trough Deformity. Aesth Plast Surg 43, 680–685 (2019).

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  • Tear trough deformity
  • Lower blepharoplasty
  • Fat repositioning
  • Transconjunctival approach