Lower Eyelid Surgery: Transconjunctival Bleph with Canthopexy & Excess Skin Removal? (photo)

My PS recommends transconj bleph ( fat repositioning) w/ canthopexy & excess skin removal for me. I have the bags, deep tear troughs & excess skin on my lower eyelids. Can I just have the transconj. bleph without getting the canthopexy & skin removed? Looking at my pics, what do you think? Is it true it's better to do canthopexy if you have the skin removed to avoid ectropion? Is the scar noticeable w/ the canthopexy or skin removal? I'm going in next week for the surgery & just wanted to make sure.

Doctor Answers 8

The villian is the valley

Several very experienced opinions havve been given but I think this operation is over ripe for a huge change of direction.

Anything that does not involve fat repositioning (best) with a pinch of skin (if it is there) or filler in the tear trough, I now believe is going in the wrong direction.

A canthopexy is an operation to fix a problem caused by an operation if the patient didn't start with lid laxiety. Certainly excision techniques have looked great but the issue is bone deficiency (negative vector of the orbital rim) and loss of fat below in alot of cases..

Columbia Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

You may wish to consider a non-surgical approach to improve the appearance of your lower eyelids.

I read your concerns and reviewed your limited photos:

Based on your limited photos, you do not appear to have large fat bags, and you appear to have lower eyelid grooves. A well-performed injectable filler treatment may lead to improvement in the appearance of your lower eyelids. You should be certain your doctor is experienced in the delicate art of filling lower eyelid grooves which may be unforgiving.

If you would benefit most from lower eyelid surgery and want to know which lower eyelid procedure might be best for you, you should get a second opinion from a reputable, experienced oculoplastic surgeon.

Hope this helps you.

Dr. Joseph


Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Lower eyelid surgery

If you are going to reposition the fat the orbital septum will be cut. In that case why make another incision inside the eye when you are already making one on the eyelid skin side? Your surgeon has the benefit of a face to face physical examination and second guesses from a few photos are inadequate. If you have misgivings about the surgery you should see another surgeon face to face for a second opinion before proceeding with surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Choice of eyelid procedure

From the diversity of answers it should be obvious that you have an issue that may lend itself  to various approaches. I would advise conservatively: transconjunctival approach, minimal fat removal and repositioning and then wait to see result.


Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Transconjuctival blephaoplasty with or without skin removal and canthopexy

From the picture on the right, in which you simulate the effect of tightening the skin with your finger, it appears that you have significant laxity of the lower eyelid.  Transconjuctival removal of fat, with or without repositioning, will not correct this issue.  There are several ways to address the issue of skin tone.  Laser resurfacing and peels can help in moderate cases, but from what I see of your pigment structure, you might risk hyperpigmentation with these approaches.  A simple skin removal is probably more benign.  The decision to tighten the lateral canthus (canthopexy) or to perform a tightening of the orbicularis muscle is based on physical exam.  Your surgeon should be able to explain his rationale for carrying out a canthoplasty and I would recommend that you discuss this with your doctor.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Lower Eyelid Surgery: Transconjunctival Bleph with Canthopexy & Excess Skin Removal? (photo)

From your photo, it does seem like you are a candidate for a transconjuctival blepharoplasty alone.  There are advantages and disadvantages to performing additional surgery.  My recommendation would be to get a second opinion with an eyelid specialist.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Asian eyelid surgery

There are various options for lower eyelid rejuvenation. In your case, tranconjunctival blepharoplasty is reasonable.  Skin removal should be done very conservatively (skin pinch) or not at all;  other options to tighten the skin include chemical peel or laser although harder on Asian skin.  Canthopexy is needed if you have lower eyelid laxity.  Consider consult with an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Lower Eyelid Surgery

On reviewing your photographs you definitely have herniated fat and would do well with some fat removal from your lower eyelids.  You do not seem to have a lot of excessive skin and so I think that a transconjunctival approach would be appropriate for you tomorrow.  Unless you have lax lower eyelid tone there would be no need for a canthopexy.  

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 18 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.