Dr. Srinivas Iyengar, a board-certified, fellowship-trained oculoplastic surgeon at San Diego Eyelid Specialists, treats under-eye bags through an incision hidden inside the lower eyelid. The outer skin stays untouched, so there's no scar to heal or hide.
This technique is called a transconjunctival approach, and it's become the go-to method for patients with noticeable fat pads and skin that still has good elasticity. Rather than cutting through the skin to remove tissue, Dr. Iyengar works from behind the eyelid to smooth the transition between lid and cheek. Read on to see how the scarless method works, who qualifies, and what recovery looks like.
How a Transconjunctival Approach Hides the Incision
The incision sits on the inner surface of the lower eyelid, where it's never exposed to light or touch. Through this opening, Dr. Iyengar repositions the fat pads that cause under-eye bulging instead of removing them outright, filling in hollow areas along the lid-cheek junction. This fat preservation is a key difference from older techniques, which often cut away too much and left patients looking hollow. A research review published through the National Library of Medicine points to this shift toward transconjunctival access as a direct response to the visible scarring and skin pulling that can follow traditional methods.
Who Benefits From the Scarless Technique
Good candidates typically have visible fat pads or puffiness paired with skin that hasn't lost much elasticity. Dr. Iyengar evaluates each patient's anatomy before recommending this approach. Benefits can include:
- No external incision or visible scar
- Fat repositioned to preserve natural volume, not discarded
- A smoother, less hollow lid-cheek transition
- Lower risk of ectropion (an outward-turning lower lid) than older skin-removal methods
- A more predictable recovery
Patients with significant loose skin may still need a small adjustment to the outer eyelid. Dr. Iyengar discusses this openly during consultation rather than assuming one technique fits every patient.
What Recovery Involves
With no external wound, there's no incision line to protect or cover while it heals. Most patients see mild swelling and bruising for about a week to ten days, manageable with cold compresses and rest. Dr. Iyengar typically clears patients for light activity within about a week, with strenuous exercise added back once swelling resolves.
Most patients go home the same day. Aftercare includes elevating the head during sleep, icing the area in the first few days, and keeping the eyes protected from direct sun while healing. Makeup can typically go back on once Dr. Iyengar gives the all-clear, and contact lens wearers can usually resume shortly after. Because there's no external stitch line, patients tend to notice fewer restrictions overall, and Dr. Iyengar follows up personally throughout recovery to catch any concerns early.
A Scarless Answer From Dr. Srinivas Iyengar, San Diego's Board-Certified Eyelid Specialist
The scarless claim holds up because it describes a real surgical technique, one Dr. Iyengar has refined through a career spent entirely on eyelid anatomy. Patients curious whether this approach fits their anatomy should start with a consultation. Contact San Diego Eyelid Specialists to schedule one.
This information is provided for educational purposes only and does not replace a consultation with a board-certified oculoplastic surgeon. Outcomes, risks, and suitability vary from patient to patient.
