Lower Eyelid Surgery (Transconjunctival Fat Repositioning) in San Diego, CA
Under-eye “bags” and hollow, sunken tear troughs can seem like opposite problems, but they’re often two sides of the same issue: fat that has become displaced rather than lost. Dr. McCoy’s approach to lower eyelid surgery is built around that distinction — instead of simply removing fat, she repositions it to correct both concerns at once, through an incision that leaves no visible scar.
Why fat repositioning instead of fat removal
Traditional lower blepharoplasty often removes the fat causing under-eye bulging. But removing fat outright can leave the tear trough — the hollow between the lower eyelid and the cheek — looking more sunken over time, trading one concern for another. Dr. McCoy’s preferred technique instead relocates that same fat to fill the hollow beneath it, smoothing the transition between the lower eyelid and the cheek rather than creating a new deficit.
The scarless, transconjunctival approach
The entire procedure is performed through an incision on the inside of the lower eyelid (the conjunctiva) — there is no incision on the visible skin of the eyelid at all. Working through this internal approach, Dr. McCoy identifies the lower eyelid fat pads and, where there’s excess fullness, carefully reduces it. The remaining fat is then carefully released and moved into the subperiosteal plane along the orbital rim — the deeper structural layer just above the cheekbone — where it’s secured in place to fill the hollow tear trough from beneath. This is done with meticulous attention to the surrounding anatomy, including the muscle that helps move the eye and the sensory nerve of the cheek, both of which lie close to the surgical field.
“With cosmetic and reconstructive work alike, I want it to look beautiful and accomplish it in the least invasive way possible.”
~Dr. Allison McCoy
One procedure, two concerns
Because the same fat is used to both reduce bulge above and fill hollowness below, this approach treats bags and tear trough hollowing as a single, connected problem rather than two separate ones — often smoothing the entire lid-cheek junction in one step.
Setting and anesthesia
This procedure is typically performed at an ambulatory surgical center under local anesthesia with monitored anesthesia care (MAC), or under general anesthesia, depending on the case and what else is being done at the same time.
Recovery
The external mattress sutures used to secure the repositioned fat are removed one week after surgery. No strenuous activity is recommended for one week. Bruising and swelling typically resolve over several weeks to months.
Often combined with other procedures
When there’s also excess skin on the lower eyelid, rather than just fat position, this can be paired with a skin pinch or laser resurfacing to address skin quality, or with facial fat grafting when additional volume is needed beyond what repositioning alone can provide.
“My favorite thing about my work is the privilege of being trusted with a patient’s vulnerable side.”
~Dr. Allison McCoy
Frequently Asked Questions
Will this leave a visible scar?
No. The entire procedure is performed through an incision inside the eyelid; there’s no cut on the visible skin.
What’s the difference between this and a standard lower blepharoplasty?
Traditional lower blepharoplasty is often performed through an external, under-the-lash-line incision and typically removes excess fat and skin. Dr. McCoy’s transconjunctival approach uses no external incision and repositions fat rather than discarding it, treating bulging and hollowness together.
Can this fix my under-eye bags and my hollows at the same time?
That’s the specific goal of this technique — using the same fat causing the bulge to fill the hollow beneath it, rather than treating them as separate problems.
Is this the same procedure referenced on the midface lift and fat grafting pages?
Related, but distinct. This page addresses primary lower eyelid bags and tear trough hollowing. The transconjunctival midface lift is a different, more involved procedure specifically for correcting lower eyelid retraction, usually after an external-approach lower eyelid surgery performed elsewhere.