Want excess skin removed under eyes. Can this be achieved with transconjunctival alone? (photo)

The puffiness (fat bags) and hollowness can be improved with transconjunctival lower blepharoplasty with fat repositioning. The skin may require conservative removal which can be done safely with skin pinch technique. See an expert.

Cosmetic lower eyelid surgery may be performed using the transconjunctival approach where fat is removed via a small incision hidden behind the lower eyelid, therefore avoiding a visible skin incision. This works well for patients who are only concerned with fat bags or the tear trough deformity and usually works best in younger patients. If you are wanting improvement in the eye bags and also want excess or loose skin removed then a Lower Blepharoplasty with an incision concealed under the eyelashes is often best. Advanced internal fixation and canthopexy techniques are used to improve the underlying support of the lower eyelid skin which helps smooth the skin and re-create a natural and youthful eyelid shape. Repairing the ageing supports of the eyelids means skin removal can be performed more conservatively, thus avoiding complications and the 'operated look' seen in older techniques of eyelid surgery.

A purely transconjunctival blepharoplasty only addresses the fat that causes "puffiness."  Treatment of excess skin can be managed by excision (resulting in a well-hidden scar under the lashes) or non-surgical means such as laser or Plasma Pen.  It appears that you may be a candidate for non-surgical management of the skin.  If you have loose/excess skin in your lower eyelids after this, touch-up with skin excision can be done under local anesthesia.

A transconjunctival blepharoplasty is an excellent option to remove the fat pseudoherniation, or bulging, which is causing the bags under your eyes. 
Oftentimes, the partial removal or repositioning of the fat pads is all that it needed to drastically improve the lower eyelid appearance.
In some cases, there remains a bit too much extra skin. In this case, a small skin pinch of skin is removed right under the lash line. 
I strongly recommend scheduling a consultation with a Board-eligible or Board-certified plastic surgeon to develop your treatment plan.

thank you for your question and photo. I do see the areas that you are looking to improve. A transconnunctival surgery can help with the puffiness and volume changes, but does not typically help with the skin changes. A small skin pinch can be useful to help the skin changes. Another option would be laser resurfacing or a chemical peel to help with the skin side of things. I would definitely recommend seeing an ASOPRS oculoplastic surgeon for this type of work. Best of luck!