Journal · Under-eye surgery
Lower Blepharoplasty vs Transconjunctival Fat Repositioning: Age, Skin Sagging, and Vector Analysis
Medically reviewed by Dr. Lee Young-geun, board-certified plastic surgeon · Last reviewed:
Transconjunctival repositioning fixes internal volume. Lower blepharoplasty fixes external skin surplus. Choosing incorrectly risks either an incomplete result or lid retraction.
In this article
The critical threshold: skin elasticity and excess
When patients in their forties or fifties consult for under-eye bags, the single most critical question is skin compliance. Transconjunctival fat repositioning works through an incision inside the eyelid, leaving external skin untouched. For patients whose skin retains good tone, the skin retracts smoothly over the newly flattened contour.
However, if loose, wrinkled skin is present, removing or shifting the underlying fat without addressing the cutaneous envelope can leave crinkled, deflated skin. In such cases, lower blepharoplasty (하안검수술) is the anatomically correct choice.
Subciliary incision and canthal suspension (Canthopexy)
Traditional lower blepharoplasty carried a risk of ectropion (eyelid pull-down) if too much skin was excised. At SINSA L Plastic Surgery, Dr. Lee performs conservative skin-muscle excision coupled with routine lateral canthopexy or canthoplasty.
By anchoring the lateral retinaculum firmly to the orbital bone, the lower eyelid margin is supported with upward and posterior vector tension, preventing rounded eyes or scleral show while delivering a crisp, rejuvenated lower contour.
Written by Dr. Lee Young-geun, Board-Certified Plastic Surgeon, Founder & Sole Surgeon, SINSA L Plastic Surgery, Sinsa, Gangnam, Seoul. Published 2026-03-09.
FAQ
Related questions
Does lower blepharoplasty leave a visible scar?
The incision is placed 1-2 mm below the eyelash line and extends slightly into a natural laugh line. Within 2 to 3 months, it fades into an imperceptible micro-crease.
What is the snap-back test?
During your consultation, Dr. Lee gently pulls your lower lid downward and observes how quickly it snaps back against the globe. This measures tarsal laxity and dictates whether canthal reinforcement is required.
Consultation
Have this assessed properly
Photographs and a short description are enough for Dr. Lee to tell you which category you fall into.
Every consultation is carried out by Dr. Lee Young-geun in person — never by a coordinator.