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Transconjunctival Lower Blepharoplasty Repairing by Fascia Fixation Transconjunctival Lower Blepharoplasty Repairing by Fascia Fixation
新一代全方位眼袋移位手術 新一代全方位眼袋移位手術

Formation of Eye Bags

With advancing age, orbicularis oculi muscle and eye skin gradually lose elasticity, coupled with the weakening orbital fascia no longer able to well enclose the fat behinds it. As a result, the orbit fat bulges and pushes through the less reinforced septum, leading to the formation of eye bags. In addition to the impact of aging and gravity, staying up late at night and puffy face will make the eye bags look more prominent.

Lower Eyelid Anatomy

The conjunctiva lines the inside of eyelids. Underneath the conjunctiva lies the orbital fat enclosed by the orbital fascia (orbital septum). Exterior to the orbital fascia are orbicularis oculi muscles and skin. The tear trough ligaments originated from the orbital rim run through the orbicularis oculi muscles and skin and attach them to the orbital rim. The skin above the orbital rim is very thin and has no subcutaneous fat. The orbital fat is held in place by the orbital fascia right under the eyes. Eye bags are mostly formed due to aging when the loosing orbital fascia (orbital septum) no longer able to hold the fat in place so the fat bulges forward. It has nothing to do with fat overgrowth. There are two ligaments (namely tear trough ligaments) lying along the tear trough groove and attaching the under-eye skin to the orbital rim. With the process of aging, the orbit undergoes continuous remodeling with resorption of the bone along orbit rim. As a result, the tear trough ligaments that attach the skin tightly to the orbital rim will pull the skin inward, resulting in deeper tear troughs.


Cross-section anatomy of lower eyelid




Aegyo-sal comes from a roll of muscle just under the eyelashes, which becomes more prominent when smiling. Aegyo-sal is considered as a symbol of beauty and charm for men and women. Famous Taiwanese model Lin Chi-ling is the representative figure of beautiful celebrities with aegyo-sal.

Eye Bag

Eye bags refer to bulging of fat below the eyes. They are mostly caused by aging when loosing orbital fascia no longer holds swell the orbital fat and the fat behind it bulges outward and presses on the skin. Some people have eye bags at younger age due to genetics or contact lens overuse.

Tear Trough

Tear trough ligaments attach the skin to the orbital rim, forming a gentle tear trough groove. When heavy bags and sagging under the eyes couples with the deflated cheeks appear due to aging, the tear trough becomes deeper and moves downward which makes the orbital rims look bigger and more prominent, giving a hollow eye look.




Orbital rim contouring/enhanced all-in-one lower blepharoplasty


lower eyelid fat repositioning + fascia repairing + tear trough filling

Three eyelid cosmetic issues get solved in one surgery


Common lower eyelid cosmetic issues include hypertrophy or drooping of orbicularis oculi muscles, loosing eyelid, ectropion, bulging eye fat and tear trough. These are generally called eye bag. In Charm United Institute we perform enhanced all-in-one eye bag surgery "transconjunctival lower blepharoplasty repairing by fascia fixation" which at once solves all issues, such as eye bag, tear trough, prominent orbital rim and black eye circle. The features of this unique surgical procedure are


  1. transconjunctival incision leaves no visible scarring or surgical trace
  2. Eliminating eye bags while keeping aegyo-sal
  3. Filling tear trough and smoothening eyelid-cheek junction
  4. Improving black eye circle
  5. Eye rejuvenation by minimizing orbital rim/ Improving black eye circle by repositioning the eye fat downward to cheek and the tear trough ligament upward. Smooth and delicate orbital rim at eyelid-cheek junction is an important symbol of youth.


Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

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