What is Transconjunctival Blepharoplasty?

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,
--DCP

I love this surgery and I am passionate about it.  This procedure in my hands gives amazing results with no cuts and no sutures.  I have done thousands of them.  Results are uniformly excellent in my hand.   The cost is not so much as this is easy for my to perform and recovery is rapid.

Thr transconjunctival lower eyelid blepharoplasty is used to remove the excess FAT from the lower eyelid region. This is often used when FAT is removed or repositioned and when the skin does not need t be excised.

Commonly, this approach is used in combination with a skin resurfacing technique such as the SmartXIDE DOT laser, when improving fine lines, wrinkles, and discoloration is important to our patients.

A skin-muscle flap is a more traditional approach when BOTH skin and fat are removed.

hello
you are asking a very technical question! Transconjunctival blepharoplasty is a type of lower eyelid surgery. Historically surgeons used to open the lower eyelid through a skin and muscle incision (subciliary incision). That approach could impair the stability of the eyelid, with a risk of ectropion. So it was found many decades ago that a solution to the problem was to avoid cutting the muscle, and approach the fat of the lower eyelid through the conjunctiva (the red tissue located at the inner aspect of the lower eyelid). 
I use the transconjunctival blepharoplasty in most of my patients to avoid ectropion, and I transpose the fat instead of removing it. 
I hope this will help.! 

Thank you for your question. A  transconjunctival blepharoplasty is a very popular procedure. It involves the meticulous sculpting of fat in the lower eyelids to improve the "bags under the eyes" look. Some doctors remove the fat, some reposition it. Sometimes a skin strip is removed at the same time if necessary.See a surgeon who performs computer imaging. That way, you can see what is realistic based on your anatomy.Best wishes.

Thank you for your question. Transconjunctival Blepharoplasty is done through the inside of the lower eyelid with no visible incision.  The fat pockets are easily removed and the swelling is less than the traditional approach. It is the  preferred method of blepharoplasty when there is no lid laxity or excess skin. If there is excess skin a pinch blepharoplasty with orbicularis muscle suspension can be performed. Please find a Board Certified Plastic or Oculoplastic surgeon who can examine you and help you with all your concerns. All the best!

Transconjunctival blepharoplasty is the technique where the fat pads are removed from the lower eyelids by entering through the back of the eyelid. This works for mild fat protrusion on young patients. For older patients with larger fat pads, it’s best to enter through the skin in order to tighten it as well. Make sure to have your surgery with an experienced oculoplastic surgeon who is comfortable with all techniques. Good luck!

Thank you for your question. Transconjunctival Blepharoplasty is a procedure to improve the appearance of lower eyelids ( fat pads) Lower eyelid surgery is very bespoke and will address the many different concerns that you may have. The incision can be inside the eye (transconjunctival incision) or under the eyelash (subciliary incision) line. The transconjunctival route is appropriate for younger patients with puffy eyes and no extra skin needing removal. The subciliary incision is more commonly used and is in patients where they have skin excess. The surgery itself can address the skin alone. In addition to this, the muscle and fat can be addressed. For hollowing of the orbital area, re-draping the fat to help pad out this area can help. The muscle layer, if dropped can also be hitched up (Canthopexy)  Your surgeon will discuss all these options with you and through the consultation and examination determine what is the best option for you. All the best 

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  Most people have a multifactorial issue meaning they have more than one problem causing this demarcation. So the difference from traditional lower lid subcilliary blepharoplasty is a non-visible scar inside the eyelid. The downfall of this is that no skin can be removed. Most of us surgeons are comfortable with both techniques it just depends on what your issue is. So if you have excess skin then the external approach may be best because we can remove some skin. If skin is not your issue and it is only a fat protrusion problem then transconjuctival is appropriate. Below I listed some of my treatment protocols. 

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

A transconjuctival blepharoplasty is a technique to address the fat pockets of the lower lid.  This approach affords your surgeon the ability to remove the extra fat from the lower eyelids via an incision on the inside of the lower lid and ultimately avoids a visible scar.  The one limitation of this approach to a lower blepharoplasty is that it does not allow the surgeon to remove any extra skin of the lower lid, and is therefore not for everyone.I would recommend consulting with a board-certified plastic surgeon to discuss your concerns, cosmetic surgery goals, and whether or not you are a candidate for a transconjuctival blepharoplasty.

A blepharoplasty usually requires contouring of the bulging fat from the upper and lower lids and skin removal. The transconjunctival approach to the lower lids is a technique to approach the bulging lower lid fat.  Often, this is combined with an incision immediatley below the lower lashes to  trim excess skin.  It is a very good approach for those who require only fat contouring.