Is there a healing time difference associated with transconjunctival vs transcutaneous lower bleph?

Does one method have a shorter recovery than the other? Is there a difference in healing discomfort, bruising or swelling?

Doctor Answers 9

Is there a healing time difference associated with transconjunctival vs transcutaneous lower bleph?

The transconjunctival approach does heal a bit faster, but the scar with the trancutaneous incision can be covered with makeup after 10 days. I still prefer the tranconjunctival approach in most patients, however. If there is lots of excess skin, a small strip of skin can be removed as well, or a chemical peel or CO2 laser tro tighten the skin. The latter two do stay pink for a month or so, but again makeup will cover it.These procedures are routinely done under local anesthesia with mild sedation. Thank you for your question, and good luck.

Savannah Plastic Surgeon
4.8 out of 5 stars 81 reviews

Transcutaneous versus trans-conjunctival approach lower blepharoplasty

In our practice, we have not performed a transcutaneous fat removal in over 25 years. We always perform the fat removal through a transconjunctival approach, which avoids violation of the lower eyelid muscle. The transcutaneous approach is only used for a skin pinch which is close with tissue glue. A trans conjunctival approach heals faster than a transcutaneous approach. The transcutaneous approach incision takes at least two months for the incision to  become minimally detectable

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 146 reviews


If only fat is removed, then likely a transconj approach probably will have less bruising.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Healing time difference associated with transconjunctival vs transcutaneous lower bleph?

The choice of procedure is primarily determined by the underlying anatomic corrections that are desired. Transcutaneous bleph involves making an incision along the lash line of the lower eyelids, elevating a skin or skin/muscle flap, and then splitting fibers of the orbicularis oculi muscle to allow access to the orbital septum and intraorbital fat.  This approach allows modification of the orbicularis muscle (resecting to reduce the bulk of the muscle, tightening the muscle, etc) as well as direct excision of fat and skin.  The transconjunctival approach allows access to the orbital septum and intraorbital fat from behind the orbicularis oculi muscle.  The fat can be resected directly, but neither skin nor muscle are resected via this approach.  The skin can be tighened with laser resurfacing or chemical peel instead of resection.  Because less structures are violated via the transconj route, there is usually less bruising and less healing time.  However, an aggressive skin tightening procedure may actually prolong the healing time compared to transcutaneous.  Since these decisions are critical to an ideal outcome, you should only seek the advice of a highly trained OculoPlastic or PlasticSurgeon, who can assess, recommend and expertly perform these types of procedures.  Good luck with your surgery!

Daniel M. Calloway, MD
Jacksonville Plastic Surgeon
5.0 out of 5 stars 31 reviews

Is there a healing time difference associated with transconjunctival vs transcutaneous lower bleph?

YES!  Transconjunctival lower blepharoplasty heals much faster than transcutaneous lower blepharoplasty. See link below.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 reviews

Trans conj vs transcutaneous

Thank you for your question.I agree with the docs below. Transconj has less bruising.The main reason against trans cutaneous is the cutting of the muscle which supports the lower lid and determines its shape. I have been an advocate of avoiding any weakening of this muscle for decades in publication and lectures.Good luck to you

Richard Sadove, MD
Gainesville Plastic Surgeon
4.9 out of 5 stars 24 reviews

Transconjunctival versus transcutaneous

In general, a transconjunctival Blepharoplasty will heal faster than a transcutaneous since the skin-muscle complex has not been disturbed with the former approach and generally there is less swelling in the lower eyelid.  If a patient could have either approach to get the same result, my preference is to use a transconjunctival approach.

Devinder S. Mangat, MD, FACS
Cincinnati Facial Plastic Surgeon
3.8 out of 5 stars 27 reviews

Transconjunctival versus trancutaneous lower blepharoplasty

There are a number of differences between the two approaches including healing, risks and results.  Not every patient is a candidate for either as one approach may be better for an individual depending on the presenting problem.  Therefore it is probably best t seek a consultation from a surgeon that does both who can help you make the proper choice depending on your needs.

Richard O. Gregory, MD
Orlando Plastic Surgeon
4.6 out of 5 stars 12 reviews

Lower lid bleph healing

Both of these are surgeries and both can produce swelling and bruising.  If you are doing just transconj work, and not taking off any skin or working at the canthus, this may heal faster.  When you go through the skin you are interrupting more planes of tissue and also can have higher incidence of complications such as ectropion.  You should expect to need at least a week or 2 with either approach.  The lower lids are very vascular, but if you don't bruise you will look good fairly quickly.  No one can promise you no bruising or swelling.  Full healing can take 6 months.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 28 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.