Background <p>Fat prolapse and tear trough deformity, indicative of lower eyelid aging, are increasingly prevalent in younger patients. Transconjunctival lower blepharoplasty (TCLB) is a suitable treatment for this demographic. However, there is currently no consensus on whether to choose fat transposition or fat transplantation when opting for TCLB. The aim of this study was to compare the surgical outcome of orbital fat repositioning (OFR) with minced orbital fat grafting (MOFG) in TCLB.</p> Methods <p>A retrospective analysis of 208 lower blepharoplasties was performed to compare minced orbital fat grafting to orbital fat repositioning during TCLB. Postoperative outcomes were evaluated by comparing baseline data, surgical duration, complications, changes in distance between pupil and lower margin of the tear trough, Barton tear trough classification, and the Global Aesthetic Improvement Scale (GAIS) between the two groups.</p> Results <p>There were no significant differences in baseline characteristics between the two groups. After a mean follow-up of 11.2 and 11.6&#xa0;months, the study group (MOFG) had a significant reduction in distance D compared with the control group (OFR). The Barton classification scores for the study group were significantly lower than those of the control group. For GAIS scoring, in both observer and patient assessments, the study group demonstrated significantly better scores than the control group postoperatively. Complications did not differ significantly between the two groups.</p> Conclusions <p>Minced orbital fat grafting achieved more favorable treatment outcomes compared with orbital fat repositioning in TCLB for younger patients.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a></p>