Candidate for Transconjunctival Blepharoplasty? (photo)

I'm a 32-year-old female considering transconjunctival blepharoplasty. I've had genetic bags under my eyes my whole life and I'm sick of looking tired all the time. My main holdup is that I'm worried about potential side effects (which I've learned about through terrifying horror stories and reviews on this site): dry eyes, hollow eyes, ectropian and troubles opening/closing lids. I'm also worried about recovery time as I only have 2 weeks off from work and don't want it to be obvious. Advice?

Doctor Answers 20

Transconjunctival Blepharoplasty is Safest Option for Removal of Eye Bags

Thank you for your question. Most of the "Horror Stories" of complications following Lower Eyelid Blepharoplasty are the result of damage to the support of the lower Eyelid caused by the External Eyelid Incision of traditional Blepharoplasty.

The Transconjunctival Blepharoplasty avoids the external incision and is done through the inside of the eyelid and was designed to AVOID these complications and preserve Eyelid support.

Be sure to consult a Plastic Surgeon certified by the American Board of Plastic Surgery or the American Board of Ophthamology with Felowship Training in Occuloplastic Surgery.

Trans-Conj Blepharoplasty

The trans-conjunctival approach to cosmetic lower eyelid blepharoplasty is very favorable. Instead of approaching the fat pads from the outside (trans-cutaneous blepharoplasty) the dissection is actually performed from behind, within the eyelid.
The trans-conjunctival blepharoplasty is usually combined with an external skin pinch, to remove the redundant skin, once the fat pads are removed and deflated.
Lower lid Blepharoplasty may be performed with a combination of local anesthesia as well as light IV sedation anesthesia. General anesthesia is not necessary, although patient preference should always be taken into consideration.
Hope this at least provides useful information. Good luck and best wishes. Dr. Shah

Anand G. Shah, MD
San Antonio Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Lower lid blepharoplasty options to treat bags under the eyes.

The transconjunctival lower lid blepharoplasty approach is a great method of removing excess lower eyelid fat. It is a conservative approach and avoids issues with ectropion, lid lag, etc.

From the photos you submitted you appear to have an under-development of your cheek bone. This is likely contributing to the long-standing problems with having prominent lower eyelid bags. You don't have enough bony support for the cheek soft tissues which gives you flattened appearance to the cheek.

Besides blepharoplasty you may want to consider addressing this lack of cheek volume. This can be done with fat grafting, cheek implants or skin fillers.

You can learn more about eyelid surgery at my web reference link below.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Transconjunctival blepharoplasty fat removal vs. fat repositioning

In your posted photos I see 2 bags in the lower lids. The upper is the muscle and the lower is the protruding fat pad. Rather than removing the fat and ending up with a sunken look suturing that fat to the deep cheek fat will smoothen the transition from lower eyelid to cheek and make it bulge outward less. That can be done via an incision on the inside of the eyelid or just under the eyelashes on the outside. That will not affect the upper muscle bulge however.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

The best candidates for transconjunctival blepharoplasty are young patients

Bags under the eyes are due to herniation of the fat that surrounds and protects the eyeball (globe), which is a very delicate structure. Unfortunately, for some individuals, that occurs at a young age such as their early 30's like you, or even in the late 20's. the eye bags may protrude. The transconjunctival approach is a great procedure for young people. This is a safe procedure. Many of the problems you found on the internet are not from a conservative transconjunctival approach for the lower lids only.

Most patients can return to work 2 weeks or even less after surgery and people should not be able to tell that you had surgery.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 126 reviews

Transconjunctival lower lid surgery

Risks should be minimal in your case and I would suggest you choose a surgeon who prefers to keep the fat rather than those that routinely remove it.  Removal of fat does eventually contribute to the hollow eyes as you age.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Transconjunctival blepharoplasty


you have minimal skin excess so a tranconj blepharoplasty would work well for you.

After 2 weeks you would probably still be a bit swollen but could return to work.

All the best,

Simon Overstall, MBBS, FRACS
Melbourne Plastic Surgeon

Candidate for Transconjunctival Blepharoplasty?

     Transconjunctival blepharoplasty is a nice option in younger patients without a great deal of skin laxity.  There does tend to be residual swelling even at the 2 week mark, but you would look better than you do now and makeup could be applied through the remainder of the recovery process.  Find a plastic surgeon with ELITE credentials who performs hundreds of eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Transconjunctival Blepharoplasty

  I think you are an EXCELLENT candidate for a transconjunctival blepharoplasty.  Of course, you can read horror stories on this site for this, and any other procedure, you might consider.  Consider choosing an oculoplastic specialist from the directory of

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 134 reviews

Candidate for Transconjunctival Blepharoplasty? (photo)

Yes you are a possible tranconj. candidate. As for 2 weeks for healing time "should" be enough but never a promise. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 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.