What is the main difference between transconjunctival blepharoplasty and lower 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!

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.

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

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. 

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.