Eyelid Surgery: Q&A

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Which Blepharoplasty Surgery Technique Works Best?

I'm looking into lower lid Blepharoplasty and have received two contraditctory opinions:

(1) that it can be done from the inside

(2) it should be done from the outside.

I don't know which procedure is best? Also, I'm interested in Fractional Laser Resurfacing and wonder if the MiXto is the right laser for me. Any comments would be appreciated.

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14 Doctor Answers | Asked by Stephie in Pasadena, CA

Doctor Answers (14)
Community Comments (0)

There may be no need for Blepharoplasty incisions at all

Based on the photo you provided, it appears that there's no need for an external incision under your lashes. In fact, you might not need any incisions at all. Of course, it's sort of a glamour shot and you're smiling somewhat so it's hard to say for sure. You appear to have hollowness under your eyes. This can be corrected either with fat transfer surgery or Restylane injections. Whatever you do, do not have any fat removed under your eyes (you don't appear to have any!) I would need to... more

Which Blepharoplasty procedure to perform

The key element here in your decision making process and why it is hard to determine from these photos is the following. Is your problem: Prominent fat deposits? Loose skin? Both of the above? If it is 1, then use the transconjunctival technique. If is is 2, then use the external approach. If it is 1 and a mild amount of 2, then use the transconjucntival technique plus fractional resurfacing. If it is 1 and a large amount of 2, the use the external approach. Although the fractional laser... more

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Best blepharoplasty procedure depends on your anatomy

This is an impossible question to answer without an examination. The "best" procedure depends on your clinical examination. If you have received different ideas from different surgeons you should either go see another plastic surgeon or even an oculoplastic surgeon (specializes in eyes) to get a third opinion! You need to be comfortable and understand your decision before you proceed....

Lower Lid Blepharoplasty

Hi Stephie, I prefer doing most blepharoplasties from the "inside" or through a tranconjunctival approach. I agree with Dr. Berkowitz regarding the benefits of this approach. If the over lying skin requires tightening, then I use Fraxel re:pair fractionated CO2 laser; sometimes I will use the older traditional CO2 laser. Mixto is a good fractionated CO2 laser. Whether it is right for you is difficult to answer without examining your skin, and knowing what your expectations are. ... more

Michael A. Persky, MD

21 reviews

Los Angeles Facial Plastic Surgeon

drpersky.com

Eyelid Surgery and the Mixto Laser A Perfect Cosmetic Pair!

Lower eyelid blepharoplasty can be performed from both the outside (transcutaneous) or inside (trans conjunctival) of the eyelid. 99.9% of the 3000 cases I have performed as an Ocular Plastic Surgeon in Sterling Hieghts, Michigan have been transconjuctival. The advantage of my technique is: NO stitches; NO skin incision, and NO Scalpel blade. I perform the procedure with the MIXTO laser. This carbon dioxide (CO2) laser allows me to gently remove the fullness ( fat) from the inside of the... more

Both inside and out

I have found in most patients that removing most of the fat from the inside and then tightening the skin on the outside works the best. In some patients who are young I don't tighten any skin or make an external incision but these are patients under 40 who I think the stretched skin from the fat will shrink back into position. So to answer your question both is a good option. Without looking at you in person it is hard to tell how much fat you would need removed if any and what the... more

Each and every surgical procedure should be individualized for the patient

Each and every surgical procedure should be individualized to the specific patient that is being treated. No single surgical technique is suitable for all patients. Having said this, my most common approach in the lower eyelids is through a transconjunctival incision (made on the inside of the eyelid so that there is no visible scarring). The surgical technique I prefer involves repositioning both the fat and muscle of the lower eyelid. Occasionally, the skin must also be removed in the... more

Approaches to lower eyelid surgeries

The lower eyelids must be evaluated in terms of excess skin, protruding fat pads (bags), and laxity of the eyelid. Only after properly assessing these issues, can the best approach be determined. It appears that your concern may be fullness of the lower eyelids without excess skin. Fat transposition is a good option because it does not result in a hollowed out look and uses the local fat to fill in the depression beneath the bags. In essence it... more

Best blepharoplasty techniques

Your photo is difficult to analyse but I can tell you that there is rarely a need to do a lower blepharoplasty for fat repositioning or fat removal with an external incision. If there is a need to remove skin then you do need an external incision but it does not appear that you would require that. You can have your lower eyelid skin tightened with a chemical peel or fractionated co2 laser if it is slightly crepey or loose.

Eyelid surgery techniques

As has been said, the "inside" technique (transconjunctival) is for fat removal or redraping which you don't need. Also, I will bet that in a non-smiling picture when the little roll of skin below the lashes is gone, you would be wise not to do any kind of bleph at this point. The last thing you want to do is to take out skin and have the lid pull down. Make sure you understand that lower lid surgery of any kind cannot produce the kind of tight smooth lower lid that you can by... more

Eyelid surgery can be done several ways.

The opinions you received are not necessarily contradictory. They are different in approach with certain advantages and disadvantages. Transconjunctival bleph (from the inside) does not allow for removal of excess skin, just removes the excess fat. External bleph requires and incision below the lashes and allows for removal of redundant skin and orbicularis muscle. From your picture, I think you would benefit most from the external approach. However, that is my opinion.

Transconjunctival lower blepharoplasty can be combined with other procedures

My preference for lower eyelid surgery is to do the transconjunctival approach since the recovery is faster and it minimizes any chance of changing eyelid shape or position. It is done from behind and except in patients with very small eyes or those who need to elevate the lower eyelids because of tearing issues or who have festoons (pockets of fluid), it is safer and more reliable in avoiding complications of lower eyelid surgery. Also, it can be combined with a laser resurfacing procedure... more

Scott Trimas, MD

3 reviews

Jacksonville Facial Plastic Surgeon

www.facesonly.com

Lower blepharoplasty with incision under lashes is best for you.

Hi! The "inside" lower blepharoplasty is not for you. That operation is used to remove fat, and you don't need any fat removed. I think you might look worse and hollow afterwards. With the "outside" approach, the tissues can be re-draped, which would help you. It's hard to be sure without seeing a non-smiling picture, but you may not need lower eyelid surgery at all.

The transconjunctival blepharoplasty is safer

I would have to see close up photos of your eyes to be certain, but in the photo you sent I doubt that you need a blepharoplasty . I do not see eye bags or puffy eyes. If all you have is wrinkling and sun damage on your lower eyelids then fractional ablative 2940 Erbium laser resurfacing is your best and safest option. The transconjunctival blepharoplasty places the incision on the inside of your lower eyelid and avoids weakening the eyelid support. The external incisional approach... more