Do I need transcutaneous or transconjunctival blepharoplasty and why? (Photos)

You will do great with a subciliary/transcutaneous approach, You have excess skin and excess fat which will improve. If your concern is having a scar, then just go ahead with the transconjunctival approach. It will still look good. I have done transcutaneous approach in skin types like yours and darker and the incisions heal very well due to their placement underneath the lash line. 

The trap here is thinking that removing a small amount of fat, and then a 'small' amount of skin by trimming is the treatment. It is not. There is protrusion of the fat for sure but you also have sagging of the skin and lower eyelid muscle unit that needs to be dealt with and suspended. All this should be done without changing the essential and natural shape of the eye. You should see someone with a ton of experience with this. Happy to answer more questions by phone.Leland Deane MD FACS

Transconjunctival lower blepharoplasty with eye fat repositioning +/- skin pinch is generally the safest method to address under eye aging changes with natural results.

Thank you for sharing your question and posting your photographs. Due to the amount of fat and excess skin, transcutaneous eyelid surgery is the right approach for you. See an experienced Oculoplastic Surgeon for comprehensive evaluation and guidance.Good luck,

If you want to reduce puffiness, then transconj is fine.  If you want to eliminate extra skin then I would certainly go external.  Once you are removing fat at all you may as well go externally completely.I used to do a combination but I think it's just extra swelling and recovery now.  Externally for someone like you is likely better.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  I prefer to remove the fat compartments with a transconjunctival approach and then excise a small amount of skin with an incision right under the eyelid tarsal plate.  This incision is not noticeable when good technique is used and minimizes the risk of ectropion.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.  
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Transconjunctival blepharoplasty just removes fat from from inside the lower lid. Transcutaneous removes both fat and skin. If your PS recommended transcutaneous then he or she likely felt that you had excess skin. The risks of both are similar. Transcutaneous, which removes skin leaves an external scar.Brest wishes.

In most patients I recommend using a combination approach. The fat pads are reduced or repositioned using the transconjunctival approach. The skin is then addressed by either using a chemical peel/laser or a skin pinch excision. For you I would use the skin pinch. This involves an external incision below the lower eyelash line and removal of  loose skin only. The muscle underneath is not cut at all. This reduces the risk of eyelid malposition that is occasionally seen with a traditional transcutaneous blepharoplasty. 
Best Regards, Prashant Soni M.D.

Thanks for the question.  If you have loose skin and "bags" under the eyes then you would need to do a transcutaneous approach for removal of excess skin and fat.   If you just have "bags" under the eyes and good skin tone, then a transconjunctival approach would be just fine.  David Robbins, MD, FACS

 In our practice, we remove all of fat through a transcontinental approach located on the inside of the lower lids. If there is any excess skin at rest, then a small pinch technique of excess skin performed on the outside of the eyelash line. In our practice, we do not recommend a transcutaneous fat removal, since  it will weaken the eyelid muscle and patients can get scleral show.