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Transcutaneous vs. Transconjunctival? (photo)

asked 7 months ago by carole494 in gunnison, CO
Latest answer by William Portuese, MD
Question viewed 540 times
Tags: comparison, costs, transconjunctival, transcutaneous

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?

17 answers to Transcutaneous vs. Transconjunctival? (photo)

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

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

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
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

Aaron Stone, MD
Los Angeles Plastic Surgeon

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

Joseph N. Togba, MD
Oakland Plastic Surgeon

www.josephtogbamd.com

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

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon

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

Edwin Ishoo, MD
Boston Facial Plastic Surgeon

www.bostoncosmeticsurgerycenter.com

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

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon

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

Peter E. Johnson, MD
Chicago Plastic Surgeon

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

Gregory Pippin, MD
New Orleans Facial Plastic Surgeon

www.pippinmd.com

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.

Steven Wallach, MD
Manhattan Plastic Surgeon

Transcutaneous vs. Transconjunctival? (photo)

Can not say which is better in your case due to very under exposed photo. My bet is transcutaneous but not sure.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Extrnal or internal approach to lower eyelids.

I charge the same whether I use an external or internal approach. The choice depends on a number of factors such as lid tightness, need for skin resection , possible mid face work, concoitant skin resurdacring, and more.... . Overhead varies greatly from practice to practice and facility to facility. Choices in anesthesia techniques can make for cosiderable cost differences.

Sheldon S. Kabaker, MD
Oakland Facial Plastic Surgeon

First, either surgery can actually be done under local anesthesia.

Many patients prefer a little less awareness so iv sedation is ideal and it does not have to be that deep. $2600 for a lower eyelid surgery is cheap so is $3400 if everything is included. Money is not the consideration here. You need to figure out who does a better surgery. Sometimes that is really hard to do so we end up focusing on cost. Without knowing the surgeons (and please do not email me their names, I am not going to choose for you) the transcutaneous... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Lower lid options

The deciding factor is the quality, amount, and ability of your lower eyelids skin to appear smooth. Most likely, at your age, the skin may be too loose. If you can pinch your lower lid skin and it stays folded, your best option is a transcutaneous approach which will tighten that skin.

Ricardo Izquierdo, MD
Chicago Plastic Surgeon

Transconjuctival vs Transcutaneous

If you have excessive skin of the lower eyelids, then transcutaneous approach is the procedure of choice. Most often transconjunctival approach is used in patients with buldging lower eyelid fat with good skin tension. The transcutaneous procedure can be done with conscious sedation and transconjunctival procedure need deeper sedation or general anesthesia.

Mohsen Tavoussi, MD, DO
Huntington Beach Facial Plastic Surgeon

Lower lid surgery

I opened the picture on my droid phone and unless I am badly mistaken the lower lid is completely covered in shadow. I use both of those approaches and do not charge a different fee and my guess is the difference is simply between the 2 doctors you chose. the inside approach is my first choice for most but it is going to be difficult to advise you without a better quality photo.

Sherwood Baxt, MD
New Jersey Plastic Surgeon

Transconjuctival vs skin

This is surgeons choice.If there is a lot of excess skin then a standard bleph is better.If the problem is just bulging or herniated fat then either approach is good.