Is it possible to have a lower blaph done the "inner" route? I was told I could only get it done the "outter" version (Photo)

Some days my bags are a 6 on a scale of 1-10 (10 being worst) and some days they are an 11. Everyone always says "you look tired". I'm 34 and I'm not tired. This is just how I look! Can I have an inner bleph? Is outter going to be obvious with big scars? This is getting done no matter what I'm just nervous about scars, it's my face. My eyes! I was already told i have way too much extra skin and no surgeon would say otherwise. Is outter really that bad? Do I have a chance at the discreet inner?

Doctor Answers 12

Incisions for Lower Lid Bleph

The 2 commonly performed techniques for lower eyelid blepharoplasty include the traditional incision just below and hugging the lower eyelashes, where the scar is well camouflaged and hardly visible, and the transconjunctival incision on the  inside of the lower eyelid, where the scar is not visible at all.  The internal approach only works well if you don't have much extra skin and this allows you to avoid a scar on the skin.  But if you need some of the extra skin removed to smooth out your lids maximally, then you will need that skin removal performed just below the lashes.  That scar usually heals very nicely.

West Palm Beach Plastic Surgeon
5.0 out of 5 stars 24 reviews

You can have blephs your way!

From your pictures it appears that you do not need to have any excess skin removed. If that is correct you do not need to have an external incision . You can have a Trans-conjunctival lower lid Blepharoplasty. Recovery is quicker and results are usually very satisfying.

Carlos Wolf, MD
Miami Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

Is it possible to have a lower blaph done the "inner" route? I was told I could only get it done the "outter" version

You have minimal to no excess skin. For that reason I would suggest the inner approach, also called a transconjunctival approach.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Lower lid blepharoplasty

A transconj incision is always the best way to go for lower lid bleph.  From your pictures, you would do well with a fat transposition where the fat is moved down into the tear trough.  At your age, there may be no need to remove skin.  If you have a little bit of laxity some laser will help to tighten the skin without any external incisions.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Lower blepharoplasty with hidden incision

The ideal (gold standard) for treating under eye bags would be transconjunctival lower blepharoplasty (incision inside the lower eyelid) with fat/bags repositioning. It is scar-less, with quick recovery. Importantly, it doesn't alter the eye shape or compromise eye closure. See following link and video. See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

Lower eyelid surgery through a trans-conjunctival approach

A lower eyelid blepharoplasty procedure can be performed completely on the" inner route", which is also known as a trans-conjunctival approach.  Fatty deposits creating the puffy look are removed from an incision located on the inside of the lower lids,  therefore there is no external incision.  For more information and many examples, please see the link and the video below 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Transconjunctival blepharoplasty is a great option for you

You are a young individual and an ideal candidate for a transconjunctival blepharoplasty. You are wise to consider the "inner" approach. Seek the opinion of an Oculoplastic surgeon experienced with transconjunctival lower lid blepharoplasties. Be sure to feel comfortable that all of your questions are answered before scheduling surgery. I do not see the excess skin in your photos, but if needed after your blepharoplasty, you could consider CO2 laser skin resurfacing which would gently tighten the skin of the lower lids - a great alternative to a lower lid incision. Best wishes.

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

Lower bleph through the inner route

Transconjunctival blepharoplasty has advantages over the transcutaneous route for many individuals.  Given your photos, this approach is not unreasonable for you.  Best advice would be to see an oculoplastic facial surgeon near you.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 114 reviews

Lower Lid Surgery By the Transconjuctival (inner) Approach

From your photos it appears as if you would do well with a transconjunctival (inside the lid) incision.  If you do not have excessive looseness of the lower eyelid, or excess skin, this gives the most natural results.From your photos, there is a hint that you may have some ocular allergies.  Do your eyes itch or swell a lot in the morning?  If you you would benefit from getting those allergies under control before surgery.  Ocular allergies can result in prolonged healing times after surgery.  In addition the chronic inflammation caused by allergies tend to "beat up" one's eyelids and tend to make your eyelid appear to age more.Obviously, only so much can be determined from a photo.  However, I would suggest considering another consultation or two before you decide what makes the most sense for you. 

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 23 reviews

You are being told this because you are seeing a general plastic surgeon.

The transconjunctival lower blepharoplasty is most frequently performed by oculoplastic surgeons who are comfortable operating close to the eye.  Some facial plastic surgeon also perform this approach.  Looking at your photographs, I think your concerns are very justified.  I fix many lower eyelid after transcutaneous lower eyelid surgeries.  See more consultations with the right surgeons.

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