Are wrinkles and hollowness a common complication in transconjunctival blepharoplasty?

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.

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.  

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,

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.

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.