Are wrinkles and hollowness a common complication in transconjunctival blepharoplasty?

Doctor Answers 12

Hollowness and wrinkles after lower blepharoplasy

Thank you for the question. Without photos, it is difficult to say exactly what is happening... however, I have a good guess. Transconjunctival lower blepharoplasty is most commonly performed to remove fat from the lower eyelid region. If this is done conservatively, hollowness can be avoided. However, if it is done too aggressively, hollowness may occur. In addition, when more volume is removed and the skin is not treated independently (e.g., with laser, peel, or skin pinch (surgical removal)), wrinkles will occur. In my practice, I prefer to transposition some of the orbital fat to preserve some volume. And I typically perform a skin pinch to remove a few millimeters of excess skin. At a minimum, a laser treatment to tighten the skin surface of the lower lids is generally required.


Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 98 reviews

Wrinkling after transconjunctival blepharoplasty

Transconjunctival blepharoplasty is more likely to result in wrinkling of the skin than is transcutaneous blepharoplasty. As fat pushes the skin outward over time, the skin will stretch a bit. Add to this the loss of collagen and elastin due to aging and you are set up for more lines and wrinkles after any blepharoplasty. In my experience, skin pinches, which remove just a little skin from the upper edge of the lower eyelid, do nothing to lessen the lines/ wrinkles on the rest of the lid. I have found that a medium peel (Jessner's- TCA 30% peel) at the time of surgery markedly reduces the risk of new wrinkles forming. Lasers are just as effective as a peel for this (but care must be taken in lasering close to the eye). Hollowing is also more likely to form after transconjunctival blepharoplasty, even if too much fat is not removed, unless the orbital septum is released at the arcuate line.

Minas Constantinides, MD
Austin Facial Plastic Surgeon
3.9 out of 5 stars 7 reviews

Problems with tranconjunctival blepharoplasty

If too much fat is removed you can have hollowness of the orbits.  This can occur with any technique of blepharoplasty.  Also if the patient has excess skin, wrinkles can be made worse with the transconjunctival blepharoplasty alone.  In those cases skin excision should be done along with the fat removal.  Transconjunctival blepharoplasty alone is usually done in younger patients with excess fat pads and good skin tone.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 43 reviews

Transconjunctival bleph

Lower lid bleph is usually done with a transconjunctival  approach.  Many surgeons will do a fat transposition where the fat pads are pushed inferiorly to fill in the tear trough.  With this surgery there will not be any hollowing as the fat is preserved.  If the fat is removed, post-op hollowing can occur and the wrinkles may appear worse.  If a patient has excess skin, a pinch of skin can be removed. This will not eliminate all the wrinkles.  Laser resurfacing can help to tighten and improve the skin texture in patients with fair skin and fine lines and wrinkles.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

Wrinkles and hollowness

Some patients may require skin excision and this can be accentuated when the fat is removed.  Excessive fat removal may lead to hollowness.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Are wrinkles and hollowness a common complication in transconjunctival blepharoplasty?

If a patient with a large, bulging fat pad and older, sun damaged skin has an aggressive transconjunctival blepharoplasty with a lot of fat removed that patient will most likely notice a worsening of their skin wrinkles and  may look hollow. 

Curtis Perry, MD
Downey Facial Plastic Surgeon
4.8 out of 5 stars 16 reviews

Complications from transconjunctival blepharoplasty

Thank you for your question. Although hollowness and wrinkles are complications from transconjunctival blepharoplasty, they are not common. Hollowness is the result of excessive fat removal. Wrinkles occur when skin was not removed, but needed to be. See an experienced eyelid surgeon for consultation.  Good luck,

Transconj bleph and hollowness

The transconjunctival blepharoplasty provides reduction in fat without undesired alteration in eye shape.  It can, however, produce hollowness, and the skin is looser.  It's a great operation for young patients with tight skin.
The conventional lower blepharoplasty, including a blepharoplasty with a 'skin pinch' alters eye shape by pulling down on the lower eyelid.  This leads to a rounding of the eye or pulling down on the corner.  In skilled hands, this is effect is subtle but you can see it if you look closely at the before after pictures.
For that reason we seldom do either.  Rather, a sub ciliary sub orbicularis cheeklift allows the cheek to be elevated, avoiding downward traction on the lower eyelid. This is a very different concept for rejuvenation of the lower eyelid but it has served us well for the past 15 years and many hundreds of cases.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 136 reviews

Hollowness is common if the fat is not preserve.

Generally most sophisticated eyelid surgeons anticipate these issues and propose a chemical peel with the lower blepharoplasty or alternative perform a skin pinch.  Consider posting photographs so we have a better idea of your concerns.  Filling the lower eyelid with a small amount of hyaluronic acid filler can soft or eliminate these issues and typically last about a year.

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

Transconjunctival blepharoplasty

patients who have the appearance of bags under the eyes and have excess fat under the eyes are potential candidates for transconjunctival blepharoplasty. This involves removal of the excess fat through an incision inside the lower eyelid. Therefore there is no external scar. In the event that excess skin is also present, it can be removed at the she same time or at a later time. It could also be addressed with laser or chemical resurfacing. In the event that too much fat is removed, a hollow appearance is possible but highly unlikely. Best Regards

Sean R. Weiss, MD, FACS
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 12 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.