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For Me, is It Transconjunctival Blepharoplasty OR the One with External Incision That is Preferred? (photo)

Good day Doctors, I am a healthy 25 year old woman, considering the blepharoplasty to get rid of the eye bags. Whether the external approach will be needed or not is what I need to know your opinion about... Is it possible that the skin will be lax after the removal of the fat by the transconjunctival approach ?? or is it unjustified fear and my youth will make the result just wonderful without me going for the blepharoplasty with the external incision approach? Thank you

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15 Doctor Answers | Asked by theyellow

Doctor Answers (15)
Community Comments (0)

Lower lid blepharoplasty

At 25 I doubt that you have excess skin. With the fat pockets protruding you may be a good candidate for a transconjunctival approach.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

A transcutaneous lower eyelid incision would be a big mistake for you.

You have a very big eye and poor lower eyelid support. The lower eyelid rides below the limbus with inferior scleral show. Transcutaneous lower eyelid surgery will weaken the lower eyelid position and lead to eyelid complications. You do have a bit of herniated lower eyelid fat. This is classically what tranconjunctival lower eyelid surgery is performed for or more recently arcus marginalis release. With the benefit of a personal examination, it is also possible... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Lower eyelids

Hello. Based on your photos , a transconjuctival approach would be great for the fat. You don't seem to have excess skin which would usually occur in older patients. Good luck

Excellent photos

First, let me commend you on your choice of posted photos. It is excellent and gives us great information. There are a few points to make here: 1. Your lower lid blepharoplasty should be done via a transconjunctival approach. You are quite young and as such need NO skin removal, and doing a skin approach to the fat would present a higher risk of lower lid retraction. 2. I would not remove any fat from the lower eyelid, but rather reposition the fat into the hollowness... more

A.J. Amadi, MD

14 reviews

Seattle Oculoplastic Surgeon

seattleface.com

TC approach

At your age, there is usually no excess skin thus a transconjunctival approach with NO external skin incision works very well.

Transconjunctival or external lower blepharoplasty approach

Your pictures do show that you have some protrusion of fat under your eyes that causes some puffiness. It does not appear that you have an issue with excess skin, which would be unusual at age 25. I would recommend the transconjunctival approach, as this should easily address the issue with the fat.

Transconj VS subciliary approach

Hello 'theyellow', thanks for your question. Being young and healthy with a firm tarsal sling for lower eyelid support and no loose skin based on your photos, I think you are a great candidate for the transconjuctival approach lower blepharoplasty. Your main concern is redundant periorbital fat herniation leading to the fullness below your eyes, which this approach should take care of. I reserve the subciliary (external) approach for older people who tend to have excess... more

I expect excellent rebound from your skin

You are only 25 years old so I would expect excellent rebound from your skin. Part of why your lower eyelid fat is accentuated is because you have a lack of volume below the eyelid in the midface. Judgement is best made based on an in-person consultation, but it appears that you could benefit from either a transconjunctival (no external incision) blepharoplasty with a small amount of fat removal and/or filler/fat placed in the tear trough and at the infraorbital rim. I would not opt... more

Or Me, is It Transconjunctival Blepharoplasty OR the One with External Incision That is Preferred?

Based upon your age the posted photos I chose transcend. approach for you. So ALL of the expert posters choose the TRANSCONJ. OPTION

Transconjunctival Subcilliary Blepharoplasty Nasal Jugal Groove

What you are percieving as puffyness is actually a combination of 2 abnormalities. The first is the protrusion of the orbital septum and fat which is made worse on upward gaze. The second cause is a deep nasal jugal groove, the hollow area below the puffy. Each of these abnormailties can be addressed transconjunctivally. I prefer to reposition the fat that is protruding into the hollow space elliminating the shadow and maintaining a full, more youthful appearence rahter... more

Transconjunctival Incision vs. Skin Incision

In reviewing your photographs you do have some bulging fat pockets but you do not appear to have any excess skin (which would be expected at your young age). Thus It would be most appropriate for you to have a transconjunctival approach for a judicious fat removal.

Fat grafting with a small transconjuctival approach

Hello, Thank you for the question and photos. Fat grafting will be an important part of improving the appearance of your lower eye lid-cheek junction. A small transconjuctival approach will also help in reshaping the fat pockets that are protruding. The link below is from one of my patients that underwent fat grafting and a transconjuctival approach. All the best, Dr Remus Repta

Transconjunctival approach to lower lids

A conservative fat removal from the inside of the eyelid(transconjunctival approach) is all that is needed for improvement

Transconjunctival Approach For Protruding Lower Eyelid Fat Removal

With protruding lower lid fat pads and a negative vector (eyeball sticks out further than your cheekbone) you only need a transconjunctival approach to your blepharoplasty. The skin will not sag afterwards.

Choice of eyelid approach.

It is true that your lower eyelids sit low which indicates laxity (that may or not be addressed later). If you are asymptomatic and are pleased with the position of your lower lids, go transconjuctivally. It causes less scarring in the tissues that cause the eyelids to become malpositionned.