Which would you recommend Transconjunctival vs. Transcutaneous Blepharoplasty? (photos)

You have significant fat pads for your age.  A transconjunctival is the method of choice for most surgeons these days.  There are usually less complications with this approach.  From the inside of the lid, the fat can be repositioned inferiorly to fill in the tear trough.  You have so much fat that some may need to be removed as well. If there is excess skin,  a pinch of skin can be removed from directly under the lash line .    

Patients with your anatomy can potentially get a good cosmetic improvement with either approach. Since a small amount of excess skin will probably be present after contouring the fat and internal support of the lid may be necessary with a canthopexy, the transcutaneous approach may produce a better longer lasting result.Following the advice of anyone who
would presume to tell you what to do without taking a full medical history, examining you, feeling and assessing your tissue tone,
discussing your desired outcome and fully informing you about the pros and cons
of each option would not be in your best interest. Find a plastic surgeon that
you are comfortable with and one that you trust and listen to his or her
advice. The surgeon should be certified by the American Board of Plastic
Surgery and ideally a member of the American Society for Aesthetic Plastic
Surgery (ASAPS) or an oculoplastic surgeon. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California