Is it better to have the Lower Eyelids surgery from the inside of the eyes?

Question

is having the lower eyelids surgery from the inside of the eyes better than from the outside? Does it cure quicker en less pain and less complications?

Mehryar (Ray) Taban, MD, FACS · Answer

The approach/incision for lower blepharoplasty is critical to not only the best results but also to avoid any unnecessary complications such as eyelid retraction, eyelid ectropion, or change in eye shape. Transconjunctival lower blepharoplasty involves making incision inside the lower eyelid with quick recovery, no visible scarring, and avoiding any of the mentioned complications. See following video and link for more details. See an oculoplastic surgeon for evaluation.

Kenneth D. Steinsapir, MD · Answer

There is no skin scar.  It does not damage the muscle that hold the lower eyelid up against the eyelid.  It heals better and has much fewer complications.  The reason that not all surgeon use it is that you have surgeons out there who are not comfortable operating close to the eye.  Typically these are general plastic surgeons who lack specialized training needed to work close to the eye.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. There are several options for surgical techniques of the lower eyelid.  The best procedure truly depends on your individual anatomy.  An in-person consultation would be very helpful for you.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your good question. There are several ways to attack puffy eyelids. Sometimes, it's better to go through the skin, while other times approaching the fat from behind the lid is preferred. The most important decision is choosing the right doctor for the eyelid surgery. Make sure you see a specialist who is very experienced. Good luck,

Elba Pacheco, MD · Answer

Performing lower blepharoplasty from the inside, allows us as surgeons to reach the fat pockets directly without having to affect the muscle that holds the eyelid against the eye, or the layer that separates the front of the eyelid from the eye socket contents. Throuh the back approach, the fat can be removed or moved into a better position to correct the tear troughs, with fewer risks. Leaving the front of the eyelid layers intact, is safer and leads to more natural results. If skin tightening is also necessary, laser resurfacing or a skin pinch can be performed at the same time.

William Portuese, MD · Answer

The trans-conjunctival approach has been the gold standard in our practice for over 25 years for removal of fatty deposits in the lower lids. It's important not to violate the muscle in the lower lids, therefore the fat comes out from the inside, and if there's extra skin, that is removed from the outside

Richard Sadove, MD · Answer

My opinion is yes. I have been an advocate of avoiding the external approach for many many years.In order to treat the fat pads in an external approach, the surgeon must pass through the muscle of the lower lid.This is where problems occur. Thus, I avoid the muscle cutting and do what needs to be done from the inside where the muscle is left intact.The photos in the web reference below are all results from the inside apporach.Good luck

Julio Clavijo-Alvarez, MD, MPH, FACS · Answer

Thanks for sharing your question. I can appreciate your concern.

yes transconjuntival approach does heal faster, however is only indicated if the skin is not redundant and you only have eyelid bags. Removal of skin will be required if excess skin is present.

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

Lesley A. Rabach, MD · Answer

lower eyelid surgery can be performed in 2 ways - one way is through an incision on the inside of the eyelid and the other is a small incision under the last line to access the same fat pads. There are pros and cons for each and it really depends on your specific issues. Generally, if you don't have too much excess skin and just a fat herniation, going inside the eyelid is the preferred technique because it can't alter your eye shape and you don't see as scar. If you have a ton of excess lower eyelid skin, then perhaps the under eyelid incision is better. I would recommend seeing a board certified facial plastic surgeon in your area for an official consultation. I hope this helps!

Is it better to have the Lower Eyelids surgery from the inside of the eyes?

Answers (9)

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