What is the main difference between transconjunctival blepharoplasty and lower blepharoplasty?

Also, which treatment would be better suited for younger patients with tight skin and puffy under eye bags?

Doctor Answers 12

Lower eyelid blepharoplasty

There is no difference. I think there was a confusion of terms. A transconjunctival blepharoplasty is a type of lower blepharoplasty. There are 2 main types of lower eyelid blepharoplasties: 

(1) transconjunctival versus 

(2) subciliary. 

The difference between the 2 is the incision placement. In a subciliary blepharoplasty, a small incision is made a couple of millimeters below your lower eyelid lashes. In a transconjunctival blepahroplasty, no external skin incision is made (unless it is combined with a small skin excision, which is sometimes necessary) and instead the surgery is performed through an incision on the inner aspect of your lower eyelid. The selection of which approach to use is depending on surgeon preference, patient factors, etc. Hope this information helps. Best wishes!


Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Transconjunctival blepharoplasty vs. Lower blepharoplasty

Transconjunctival lower blepharoplasty diminishes the fat pads in the lower eyelids and does not treat the skin. At the same time, laser resurfacing can be performed to smooth out the lower eyelid skin. A lower blepharoplasty can deal with excessive skin fat in the lower eyelids. With this procedure, there is an incision under the lash line and laterally in the corner of the eyelid.

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
4.0 out of 5 stars 7 reviews

Transconjunctival vs transcutaneous lower lid blepharoplasty

There are two main approaches for lower lid blepharoplasty - an incision in the skin or an incision on the conjunctival side of the lid. In addition, the laxity of the lid margin has an impact on the extent of the procedure and should be accurately assessed by the surgeon. In young patients the transconjunctival approach is appealing because the incision is hidden, and skin does not usually need tightening/removal. An evaluation by an Oculoplastic surgeon is optimal because of the capability of assessing the horizontal and vertical mechanics of the lid - i.e., does the lid require horizontal shortening to avoid the complication of ectropion or retraction after blepharoplasty. Oculoplastic surgeons have the capability of assessing the ocular surface and health of the eye before, during, and after cosmetic lower lid blepharoplasty. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Blepharoplasty approaches: Transconjunctival vs. Transcutaneous

Lower blepharoplasty is a surgery to address the lower eyelid and the fat compartments under the eye.There are a few approaches to the fat compartments. Transconjuctival approach goes on the inside of the eyelid. Transcutaneous goes through the skin below the eyelashes. You may also hear the term subciliary.If there is no need to tighten the eyelid or remove skin, the transconjuctival approach is frequently favored as it avoids a scar and other issues that can occur when operating on the lower lid. I would have a discussion with your surgeon regarding your surgical needs and the intended approach for a safe and happy outcomes. Safety comes first. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Transconjunctival blepharoplasty is lower blepharoplasty.

I think you are asking what is the difference between a transconjunctival vs transcutaneous lower blepharoplasty.  Transcutaneous lower blepharoplasty is more commonly practice by general plastic surgeons and transconjunctival lower blepharoplasty is more commonly practice by fellowship trained oculoplastic surgeons who are board certified eye plastic surgeons who are much more comfortable to working close to the eye.  The problem with the transcutaneous approach is that is damages the motor nerves that supply the muscle that helps hold the eyelid margin against the eye.  For this reason it is much more likely to cause complications.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Blepharoplasty Techniques

Thanks for the question.  A lower blepharoplasty is the overall term used for a surgical intervention to improve the appearance of the lower eyelids regardless of the technique.  The lower eyelids consist of three anatomical layers, skin, muscle and fascia, and the orbital septum.  The orbital fat pads lie behind the orbital septum.  A transconjunctival approach to a lower blepharoplasty allows for removal of excess orbital fat pads via a conjunctival (or internal eyelid) incision avoiding an incision on the skin.  The transconjunctival approach works best in younger patients with good skin but excess orbital fat pads resulting in bulging of the lower eyelids.  The transconjunctival approach also allows for use of laser resurfacing of the lower eyelids in combination with the transconjunctival removal of orbital fat.

Lower eyelid blepharoplasty and transconjunctival blepharoplasty

Thank you for your question. The lower eyelids can be approached to remove the fat causing the puffiness thru the skin with an incision just below the lashes in a naturally appearing crease. This cuts thru the muscle and can sometimes lead to rounding of the eyelid. By making a small incision on the inside the fat can be removed without the need to cut thru the muscles. If the person is older and requires skin tightening, this can be performed with a small skin removal or laser or peel tightening.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 20 reviews

Transconjunctival lower blepharoplasty

Transconjunctival just describes the approach used for the lower blepharoplasty, the other common approach being transcutaneous. 

Most modernly trained surgeons are going to favor the transconjunctival approach due to its increased safety profile, superior long-term outcomes and ability to perform other procedures simultaneously.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut
#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 76 reviews

Lower blepharoplasty procedure

  A lower blepharoplasty procedure is performed when there is puffiness in the under eye area and/or excess in loose skin. In our practice, we perform a trans-conjunctival approach with the incision placed on the inside of the eyelids for fatty bag removal to rejuvenate the eyelids in all patients. When patients are over 50 years of age, and have excess loose skin  in the lower lids, then a small skin incision is performed on the outside directly underneath the eyelashes. This is called a pinch technique  and the incision is closed with tissue glue. No sutures are necessary in the lower lids. For more information and many examples of lower blepharoplasty through trans-conjunctival approach, please see the before-and-after results below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Trasnconjunctival Versus Subciliary Blepharoplasty

There are two major differences: the location of the incision and the goal of the procedure.  Generally speaking, a transconjunctival approach utilizes an incision on the conjunctiva (the inner lining of the eyelid) and is used to remove/re-position excess orbital fat.  It can also be utilized, depending on the surgeon, to perform a cheek lift.  A subciliary approach utilizes an incision trough the skin, and then a secondary incision through the orbicularis oculi muscle at a lower level.  This approach can be utilized to remove/re-position orbital fat, re-position the cheek, and remove a small amount of skin.  Either approach can be used by a skilled Surgeon, but the decision to use one approach over another is usually based on the age and anatomy of the patient.  As with other surgical procedures, the critical factor is the skill and experience of the Surgeon, not the approach. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 82 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.