Transconjunctival orbital fat repositioning is a widely used transconjunctival approach in patients with tear trough deformities and extruded orbital fat, without scarring from skin incision.

With internal fixation method (IFM) on pedicled fat, fixation can be more stably done with little risks of recurrence and no requirements of removing sutures or keeping bolsters after surgery, but it requires a long learning curve due to the narrow surgical field.

Externalized percutaneous suture method (EPSM) is a more widely used procedure due to its ease of operation and feasibility of placing pedicled fat more distally from the dissected space. However, it could be a quite uncomfortable and cumbersome procedure in that patients should postoperatively keep bolsters on their skin for 3–6 days and revisit for suture removal.

Therefore, we have designed an IFM using barbed thread for easy internal fixation, without a postoperative necessity of keeping bolsters.