Transcutaneous vs. Transconjunctival? (photo)

I am a 63 year old woman with fairly good skin tone but I am developing bags under my eyes. I went for two consults and got two opinions. The first dr suggested a lower lid transcutaneous blepharoplasty at a total cost of approx. $2600. The second recommended a lower lid transconjunctival blepharoplasty at a total of $3400. How do I choose and why the difference in costs?

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17 Doctor Answers | Asked by carole494 in gunnison, CO

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Transcutaneous vs transconjunctival blepharoplasty

Transconjunctival is the gold standard method to remove fat pads from the lower lids. Transcutaneous incisions violate the orbicularis oculi muscle of the lower lids and lead to more complications, including scleral show, rounding, and ectropion. It is best never to violate the muscle by a transcutaneous approach. Transconjunctival approach is an approach performed on the inside of the lower lid whereby the fat pads are removed. If there is excess skin on the lower... more

In lower lid surgery which incisional approach is best?

The excess fatty tissue ("bags") and skin laxity of the lower lids can be well -managed using a variety of approaches. The transcutaneous (skin) incision has pros and cons: while a skin incision and small scar is created, visibility and manipulation of excess fat may increase and sometimes additional tissue tightening may be possible. Likewise, the transconjunctival (behind lid) incision does not create a visible skin incision but access to fat manipulation and tissue... more

Donn R. Chatham, MD

6 reviews

Louisville Facial Plastic Surgeon

Lower eyelid bags

Your photo shows lower eyelid bags but the dark shadow does not allow much more assessment. Furthermore the photo is a still frozen in time. It does let me know how the bags change with eye movement or what the laxity of the lower eyelid is. Therefore no one can make a recommendation of any worth based solely on this photo. Choosing between the 2 approaches to lower eyelid surgery depends on what the goals of the surgery are. If you are just going to remove some fat from inside the... more

Lower lid blepharoplasty approach

Hi Carole. Either approach to your lower lids will result in an improvement. Your photo does not allow me to evaluate the skin changes - are there fine lines, wrinkles, capillaries etc. Another factor that helps us to determine the best approch is the reslience of the lower lid when it is pulled away from the eye ball - the snap test. If the skin is smooth and the lower lid snaps back as soon as it is released then the transconjunctival approach... more

Transconjunctival vs. Transcutaneous Blepharoplasty

Both transconjunctival and a transcutaneous approach to your lower blepharoplasty will provide improvement. The difference between the two is in how much improvement you will get and at what risk and cost to do so. At your age with more loose lower eyelid skin, a transcutaneous approach would give a better result but at a higher cost and with the potential risk of lower eyelid malposition afterwards and a longer period of swelling and bruising. You need to consider each of their... more

Blepharoplasty at 61

Given the extent of anticipated skin laxity with decreased lower lid tone and skin excess, in my practice I would suggest a subcilliary / transcutaneous approach with tarsoraphy and tarsal suspension. I believe transconjuctival approach even with skin pinch will be insufficient correction of lid laxity and extent of redundant skin excision would be more difficult to judge with this technique vs. trascutaneous. I would also suggest searching for the surgeon with most experience in this... more

Transcutaneous vs. Transconjunctival?

First let me start out by saying that I published a scientific paper, in the early 1990's, comparing the results and potential complications of a transcutaneous versus transconjunctival lower Blepharoplsty (eyelid surgery). The paper concluded that the transconjunctival lower eyelid surgery yielded superior results with less comlications and IMHO has been the gold standard in lower eyelid surgery since the 1990's. Price differences reflect many things. Level... more

Transcutaneous lower lid rejuvenation

Your best option is a transcutaneous blepharoplasty as at age 61 there will be an issue of skin excess as well as fat which is addressed through the transconjunctival approach. Choose a surgeon you can trust and understand, with board certification. Cost is a variable though important if you are unhappy with your experience or results. Best of luck, peterejohnsonmd.com

Transcutaneous blepharoplasty would be a better option

Based on your photo, it appears you have significant orbiculars oculi laxity. You would benefit from tightening of this muscle and suspension of it from your orbital rim (orbicularis suspension). Your may also need lower lid tightening as well. A formal consultation is required to see what would be best for you. Warmest regards. Dr. Pippin

Blepharoplasty

Fees vary from doctor to doctor. As for the technique, it depends upon what is needed. If you have loose skin, then some skin can be removed transcutaneously. If not only going transconjunctival is fine. I usually do a transconjunctival for fat removal, and if skin is needed to be removed I often do a skin pinch and try not to violate the muscle. Often I combine it with a canthopexy to support the lower lid.