What is Transconjunctival Blepharoplasty?

A friend mentioned getting Transconjunctival blepharoplasty.  What does this mean? Is it better than traditional eyelift surgery? I'm 52 and would like to help my under eye bags.

Doctor Answers 89

Transconjunctival blepharoplasty

The transconjunctival blepharoplasty is my favorite approach to lower eyelid surgery; I use it more than 90% of the time. It allows for easy and safe access to the fat that can be either removed or repositioned over the cheek bone. It reduces the risk of the eyelid pulling down as it heals (ectropion). Another benefit is the absence of an external incision, but this may not be the case for everyone.

After the fat is removed, the skin that was being tensed out by the fat can either retract back nicely or wrinkle. In the presence of this wrinkled excess skin, a small procedure called a skin pinch will take care of it. This does leave an external incision just below the lashes but heals remarkably well. Even with this 2 step approach, I believe that it is safer and the results are great.

I routinely perform this under local with oral sedation. This is one of the few procedures I can anesthetize the patient without them ever feeling anything.

Lone Tree Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

Transconjuctival blepharoplasty

For blepharoplasty patients with true lower lid skin excess or redundancy, some skin must be removed to restore a youthful appearance. This is performed through a subciliary incision, which is an incision placed immediately below the lower lid lashes. This incision is hidden by the lower lid eyelashes and is almost always imperceptible once it has healed.
As with upper lid, skin excision of the lower lid should be very conservative, amounting to only that amount of skin that is necessary to improve the lower lid skin contour. The muscle layer below must remain completely undisturbed, as it provides horizontal support for the lower lid and helps to maintain the lid position flush against the surface of the eye. Excessive removal of lower lid skin may lead to a complication called ectropion, where the lower lid is pulled down and away from the surface of the eye. This complication often requires additional surgery to correct it, and must therefore great care must be taken to avoid it.
In eyelid surgery patients that do not have adequate lower lid tone or support, and in any patient felt to be at some risk of ectropion, a lateral canthopexy is performed to protect against that potential problem. The lateral canthus (the lateral corner of the eye) contains a tendon that attaches the lower lid tissues to the orbital rim laterally, and this tendon serves as a 'clothesline' that maintains lower lid position. A lateral canthopexy consists of an anchoring or supporting suture that tightens that tendon and thus the lower lid as well. When desired, a lateral canthopexy can also elevate the position of the lower lid. In patients who desire it, this procedure can produce a more 'almond' shape to the eyes.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Transconjunctival blepharoplasty

We are as individualized as our finger prints. That’s why a treatment for your lower eyelid surgery needs to start with you in mind. By that I mean there are multiple techniques available to operate on the lower eyelids and what works for your friend will not necessary work for you. Unfortunately some surgeons know of only few techniques and they use them on everyone they see. That’s why when choosing an eyelid surgeon, make sure they have experience in this field and at least they are oculoplastic surgeons.

Transconjunctival blepharoplasty is a surgical technique that the incision is made on the inside for access to the orbital fat. In the old days, all surgeons would just remove fat to decrease the bulkiness of the lower lid bags. The problem with doing that is that it can lead to post operative “hollowness” and does not really address the problem. Our newer techniques replaces and or repositions the fat to give you a natural not artificial look.

Kami K. Parsa, MD
Beverly Hills Physician
4.9 out of 5 stars 38 reviews

Fewer complications with transconjunctival.

The more modern transconjunctival approach was not designed to avoid a visible incision, as some people imply. It was done to reduce the chance of a specific complication with the external or subciliary approach. The older approach required cutting through the muscle and orbital septum of the lower lid and it carried with it a higher risk of lower eyelid rounding or ectropion (where the eyelid pulls down and away from the eyeball). These are bad complications.

The transconjunctival approach, on the other hand, avoids this pitfall by accessing the fat from the inside of the eyelid, leaving the muscle and septum intact. And contrary to some assertions by my colleagues, loose or excess skin can still be addressed, It's done through a "skin pinch" excision on the outside without going through those muscle and connective tissue layers.

So much lower is the complication rate with transconjunctival blepharoplasty that I (basically) never do it any other way. And most of the time I'll also combine it with a skin pinch.

The thinking is simple: get the fat from the inside, get the skin from the outside, and leave the middle structures alone.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

How to get rid of under-eye bags: the transconjunctival approach

To understand what "transconjunctival" means, let's ask "why do we get under-eye bags in the first place?" Well, baggy eyelid people have mom or dad to blame. It's caused by fatty deposits behind the eyelids that bulge forward and even young people have under-eye bags because mom or dad probably had them, too. As we celebrate more birthdays, we can develop even more eyelid bulging and wrinkles that even Botox can't smooth - look at Bill Clinton's eyes before and after skillful de-bagging!. But for young and mature alike, there still is hope! If bags are the only issue, then we can get to those pesky fatty deposits by pulling the eyelid forward and accessing them from the inside. If you've ever flipped your upper lids inside-out, then you know what the "conjunctiva" looks like - smooth and shiny, the "conj" lubricates the eyeball. Same thing on the inside of the lower lids. "Trans" means "going through," or "across," hence the mouthful that surgeons use to describe this approach means "going through the shiny inside lining of the eyelid." And, that's why it's scarless, because the scar is totally hidden (unless you walk around with your lids flipped out). Avoiding having a visible scar is the reason we use this approach. A picture is worth a thousand words - look at the eyelid surgery patient in my gallery - she was treated by this method. All in all, it's a very safe way to finally check those bags at the door and give your eyes a rested, youthful appearance. BUT, be sure that you are in the hands of a board-certified plastic surgeon who does a lot of aesthetic eyelid surgery. This is a must!

Ariel N. Rad, MD, PhD
Washington DC Plastic Surgeon
5.0 out of 5 stars 51 reviews

Transconjunctival Blepharoplasty

Transconjunctival Blepharoplasty is a technique used for removing the fat (bags) of the lower eyelids using an incision on the inside of the lower eyelids.

This technique avoids a visible scar, does not remove skin, and can prevent certain scarring complications of traditional (subciliary = below the lash line) incisions.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.6 out of 5 stars 39 reviews

No Visible incisions with Lower Eyelid Surgery Using Transconjuctival Technique

Transconjuctival Blepharoplasty allows removal of the excess fat of the lower eyelid. This is done by making the incision inside the eyelid which leave no visible external scars.
This technique can be combined with other techniques depending on the amount of skin excess, wrinkles and line of the lower eyelids and laxity of the lower eyelid.

Generally speaking it is a very good idea not to remove the fat which can lead to hollowing of the orbit and dark circle around the eyes. A better option is to re-drape ( or reposition) the fat over the bony orbit rim to create a natural and soft transition zone to the cheek junction.

Hope this is helpful.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 195 reviews

Transconjunctival blepharoplasty is my preferred approach to lower eyelid surgery

Transconjunctival blepharoplasty is my preferred approach to lower eyelid surgery in the majority of my patients.

The “conjunctiva” refers to the inner lining of the lower eyelid, continuous with the clear outer lining of the eyeball. In this approach, an incision is made on the inside of the eyelid, carefully protecting the globe of the eye (eyeball). This provides direct access to the peri-orbital fat that is contributing the puffiness around the lower eyelids. This approach has many advantages: since the scar is on the inside of the eyelid, there is no visible scar following surgery; the risk of scar contracture with secondary “ectropion” is eliminated through this approach; bruising is often minimized through this approach as well.

While removal of excessive skin in the lower eyelid is often not required to achieve the desired rejuvenation around the lower eyelids, I will occasionally do a “skin pinch” excision of excess skin in the lower eyelids – immediately adjacent to the eyelid margin – along with a transconjunctival approach for removal of any excessive fat around the eye.

Occasionally, in lower eyelid blepharoplasty, removal of fat is not the principal goal. Instead, repositioning of the eyelid fat may be more appropriate to address any contour irregularities or “hollow” look in the lower eyelids – this fat repositioning or recontouring can be most easily accomplished through the transconjunctival approach.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
4.6 out of 5 stars 18 reviews

Transconjunctival blepharoplasty, technique to remove fat from lower lids

Transconjunctival blepharoplasty has been around for over twenty years. It is a  technique to simply remove fat, underneath the lower lids whereby an incision is made at the subconjunctival area  on the inside of the lower lid, and the fat is removed out of the three compartments in the lower lid. We use the trans-conjunctival approach for fat removal exclusively in our practice. The fat compartments in the lower lid are what create puffiness and bags, causing a tired look. This needs to be done under general anesthesia because of the pain associated with teasing fat out from the orbital septum. The reason that trans-conjunctival approach is very popular is because it alleviates the need to transect the muscle which was performed on older  techniques from the outside approach. Transecting the muscle from an outside approach can lead to a scleral show or pull down affect of the lateral portion of the lower eyelid and give a sad eye appearance. There is only minimal mild pain after the surgery. For many examples of eyelid surgery, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Lower Eyelid surgery Techniques- Transconjunctival Blepharoplasty

There are two approaches for lower eyelid Blepharoplasty- subcilliary incision and transconjunctival incision. Transconjunctival incision is basically made on the inner part of the lower eyelid. through this incision only excess fat can be removed. To the contrary the subcillary incision is placed on the outside at the lower cilliary margin. this incision enable the surgeon to excise excess orbital fat as well as to remove loose lower eyelid skin and tighten muscle. Transconjunctal incision is mostly used for young people who do'nt have any lower eyelid excess skin, but just bugling fat.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 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.