Would you recommend a transconjunctival lower eye lift or outside incision with canthoplexy?

It's been confirmed by several doctors that I need 4 lid surgery with canthoplexy as I need fat repositioned and have excess skin. I an 64 years old and have received differing opinions whether to do in transc or outside incision

Doctor Answers (10)

Would you recommend a transconjunctival lower eye lift or outside incision with canthoplexy

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   Skin laxity among other aspects would need to be examined to answer this question.  If there is skin laxity, skin removal will be necessary.

Kenneth Hughes, MD

Los Angeles, CA


Los Angeles Plastic Surgeon
5.0 out of 5 stars 237 reviews

Eyelid surgical techniques

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Without a consultation and evaluating the laxity of the eyelid and skin, it isn't possible to tell you which approach is best.  Generally if the eyelid is not too lax, a transconjunctival approach is preferred. Often I recommend repositioning fat rather than just fat removal since repositioning can create a smoother contour in many patients. Some patients benefit from laser treatment at the time of the surgery rather than skin removal to tighten the skin and minimize the chance of an external scar.  An oculoplastic surgeon usually has the most experience in treating this delicate area and providing the most natural appearing result.  In many cases, I talk patients out of surgery if volume loss in the face is the issue and treat them with long lasting fillers instead so they don't have a "hollow" look after surgery.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
5.0 out of 5 stars 29 reviews

Eyelid surgical techniques

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In most patients some repositioning of the herniated fat is beneficial to fill in the tear trough zone.  Also a tightening of the orbicularis muscle is beneficial to relieving some of the downward pull of the lower eyelid.  It may be that you have some existing laxity of the lower lid and a cantholysis and canthopexy may be beneficial.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

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Lower Bleph - transcutaneous or transconjunctival with canthopexy?

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No photograph was submitted. If however you need a canthopexy it is very likely you would need a transcutaneous or external incision lower blepharoplasty. If the issue is mostly herniated fat and there is no need for a canthopexy then perhaps a trans-conjunctiva on (internal eyelid incision) laser treatment of the skin laxity would be sufficient.

Richard O. Gregory, MD
Orlando Plastic Surgeon
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Lower eyelid surgery

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A lower eyelid blepharoplasty can be performed through a transconj incision or an external incision. If one needs skin removal the external incision will be necessary as well.

Steven Wallach, MD
Manhattan Plastic Surgeon
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Upper and Lower eyelid surgery

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Without photographs, it's impossible to give an opinion on what may or may not be needed. In our practice, the primary goal of upper eyelid surgery is to remove occluded skin and a little bit of fat. The primary goal of lower eyelid surgery is to remove the herniated 3 fat compartments in the lower lids and a small amount of skin excess and needed. We perform a conservative fat removal on the lower lids through a trans-conjunctival approach. Any excess skin that is present is removed through a pinched technique and closed with tissue glue. There are no sutures on the lower lids. Most people do not need a  canthopexy, unless they have sad or down turned lower eyelids. For many examples and more information, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

External lower blepharoplasty is what you need.

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External lower blepharoplasty is what you need.The reason is you probably have excess skin the needs to be remove as well as fat repositioning. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Blepharoplasty Question

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A physical examination is necessary to answer your question. Depending on the patient and surgeon, both techniques are acceptable and the standard of care. Hope this helps

George C. Peck, Jr, MD
West Orange Plastic Surgeon
5.0 out of 5 stars 16 reviews

Eyelid surgery

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Chloesasha, know when can give you a good opinion without adequate photos or an exam.  I can tell you that most of my lower lids are done trans-conjunctival and I prefer a "SOOF lift blepharoplasty".  You may want to find someone who is familiar with this procedure.  I can also tell you that most patients I see who are in their 60s do not necessarily need there upper lids done rather they need surgery done on their brows.  I hope this helps, good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

Lower eyelid options

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There are several ways to do a lower lid blepharoplasty.  If you are going to have a fat repositioning  this is usually done through transconjunctival incision.  If you need skin taken off, this can be done by excising a pinch of skin under the lashes after the fat has been moved.  And if you need tightening, a small incision is made at the outer corner of the eye to do this.  Some surgeons still prefer an external approach for the surgery.  The results with this can also be very good if done correctly.  There is a slightly higher incidence of lower eyelid retraction after opening up the lid with this surgery.  You have to find a surgeon that you are comfortable with, and look at some of their before and after pictures to see if you like the result they obtain.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
4.5 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.