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Which Blepharoplasty Technique is Best? (photo)

I'm 45 years old and considering upper and lower blepharoplasty. I've had 2 consultations thus far and 2 different opinions. Lowers - 1st - transjunctional with fat repositioning + TDA peel. 2nd - fat repositioning and slight skin pinch (no peel). One eye has prominent herniated fat, deep crease and is very dark underneath. Other eye not as bad. I was considering the uppers as well to open my eye a bit more and show slightly more lid but a little concerned if that as I age I may start to look hollow?

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19 Doctor Answers | Asked by smb116 in nyc

Doctor Answers (19)
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blepharoplasty technique

A trans-conjunctival approach with either fat repositioning or conservative fat removal would give a nice result for the lower eyelids. A small pinch of skin known as a pinch technique would be better than skin peeling. A skin peel on the lower lids may erase freckles which would leave the lower lids looking unnatural. A conservative amount of skin and a small amount of medial fat can be removed from the upper lids to open up the skin crease... more

Transconjunctival blepharoplasty is best for you, along with avoiding skin removal

There are a lot of factors to why lower eyelids look sagging, tired and puffy. In my practice, fat transposition or repositioning is just a limited part of the procedure. Addressing the excess fat that herniated forward is a more significant part of what we do. There are even MRI studies that show people who not only have a hernia of fat, but also have excess fat pockets, meaning, there’s an increase of volume. The surgeon’s experience and how they look at your before and after results... more

Eyellid surgery, avoid Hollow Eye results

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed. As with... more

Michael Law, MD

17 reviews

Raleigh-Durham Plastic Surgeon

michaellawmd.com

There is no one correct lower eyelid operation.

I most commonly performed lower blepharoplasty by making an incision along the lash margin in dealing with the fat and skin in various ways. Occasionally the trans-conjunctival approach is suitable. There is no one correct way to do the operation. Go with the surgeon you trust the most.

Tranconjuctival Blepharoplasty Techniques

Thank you for posting your pre-operative photographs. Obviously, you are asking for the procedure that will rejuvenate your eyelids with the most natural results. Examination of your photos reveals lower eyelid asymmetry with more herniation of the inner fat pad. You have a deeper lower eyelid crease or tear trough deformity on your left. This is caused by loss of bone along your left orbit. This can be corrected by repositioning the lower eyelid fat through a transconjuctival incision or... more

Blepharoplasty techniques

Either option can achieve the result you are looking for. Trans-conjunctival approach to lower eyelids is a safe way to perform lower blepharoplasty. Skin pinch, peel, or laser resurfacing are all well-established modalities that can help with lower lid skin tightening. As evident from other answers, there are additional nuances in deciding whether fat repositioning or grafting would be of benefit. Other views and exam would be beneficial in this regard. Good luck, Grigoriy... more

Blepharoplasty options

Either option can work well for the right patient. For you, peel may be better because it would also diminish the pigmentation spots you have on your lower eyelids and face. See an oculoplastic surgeon.

Transconjunctival

I prefer a transconjuctival approach with conservative fat excision and a skin pinch blepharoplasty.

Transconjununctival fat repositioning

For your case, fat repositioning would be most ideal so deal with the bagginess of the lower eyelids. For the skin treatment, its hard to say with a photo alone. Skin texture, lower eyelid tone need to be assessed in person to determine whether skin peel vs laser vs pinch excision would be best.

A.J. Amadi, MD

14 reviews

Seattle Oculoplastic Surgeon

seattleface.com

Blepharoplasty options

I would tend to favor a transconjunctival lower blepharoplasty with fat repositioning and conservative removal based upon the photos you submitted. It does not appear that you have much lower lid skin and a peel or laser resurfacing would help tighten the skin and improve pigmentation issues. Good luck.

Scott Trimas, MD

3 reviews

Jacksonville Facial Plastic Surgeon

www.facesonly.com

Upper and Lower Blepharoplasty (Eyelid Surgery) Options

Thank you for the question and your photo. It would be useful to see a profile and 3/4 view to determine the relative projection of your cheekbones. In addition, an exam in person is needed to check the laxity of your lower eyelid. I agree with some other assessments that volume would be helpful. In appropriate patients, I use the orbital fat and transpose this over the orbital rim to fill in the hollow area. When there isn't enough fat, I recommend fat grafting to my patients. For the upper... more

Upper and Lower Eyelid Surgery

I agree with the consultant who suggested lower eyelid transconjunctival approach with fat re-positioning I do not think at your age there is any need to make incisions on the lower lid. I would also suggest some volume augmentation to the cheek in the form of fat grafting. Lastly, I would suggest laser skin resurfacing in the lower lid to achieve a small amount of skin tightening. I would also agree with a "skin only" upper blepharoplasty which would... more

Blepharoplasty options.

If there is excess skin that is significant then you need an external incision. Otherwise transconjunctival is ok. Your uppers should be left alone and have a browlift instead to prevent hollowness and give you a "happy" look.

Toby Mayer, MD

7 reviews

Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Best Blepharoplasty Technique

In looking at your photographs, I am not certain that what your consulting surgeons have diagnosed as herniated fat is in fact that. The fullness in the lower eyelid appears to be in a location that is consistent with orbital rim or bone. This means that you and your surgeons are likely to be quite disappointed with a lower eyelid surgery. I think that fat removal will do almost nothing for you. On the other hand, you do have a face full of freckles. A lower... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Eyelid surgery

It would be very helpful to see profile view. It appears that your cheek is very flat. In these cases fat transposition will often not provide enough volume to contour the midface into the lower eye. A transconjunctival approach is used to remove bulging fat and then a fat transfer can contour the midface region. By adding volume to the midface you will create a frame for the eye and be less concerned about creating a hollow appearance with an upper blepheroplasty... more

Mark Glasgold, MD

14 reviews

Bedminster Facial Plastic Surgeon

glasgoldgroup.com

Blepharoplasty

I still like to do a lower lid via the transconjuctival approach and remove some of the excess fat and reposition when needed. For the skin -- at your age, you may not need any removed, if you do a pinch will do and a TCA peel helps too. You may need the uppers done too. You need an in person consultation to know for sure.

Fat repositioning works well for lower blepharoplasty.

Hi. 1) You look like a good candidate. I would be inclined to do fat repositioning and then treat the skin with bimodal erbium laser resurfacing. So no incision in lower lids. You do have some asymmetry. 2) Skin only upper blepharoplasty also good idea.

Eyelid surgery

I agree that you need a lower lid bleph. It isn't uncommon for one eye have more prominent pseudoherniation of the fat pad than the lower. I personally recommend having the eyelid surgery first, letting it heal and then assessing whether a peel would be beneficial. In terms of the upper lids, I think it would be helpful but the first step is always to examine the patient and determine whether the cause is sagging in the lids or is based on brow ptosis. The upper lid issue is definitely... more

Eyelid surgery options

Dear smb116, Since you live near NYC, you should consider seeing the Glasgold Group in New Jersey I prefer a third method that I learned there, transconjunctival approach with fat grafting to precisely and reliably sculpt the lower eyelid I performed this procedure on my patients, even had my family member have surgery with them and the results are fantastic Best regards, Nima Shemirani