Outer cut or inner cut if I have some crinkling? (Photos)

Two consults: one transcontinental with skin pinch and fat repositioning from abdomen. ( way too expensive) The other outside cut with fat from bags draped Over tear trough. ( affordable but worried about eye shape change) I am 45 m so confused. Please help.

Doctor Answers 14

Lower blepharoplasty

There are many options for treating this area. Based on your photos, it looks like you would be a good candidate for transconjunctival lower blepharoplasty with fat repositioning (from the periorbital fat pads themselves). You may need some treatment to the surface of the skin later if there is still some laxity. It does not look like you need any skin excised.

Columbus Facial Plastic Surgeon
5.0 out of 5 stars 47 reviews

This should be addressed with a transconjunctival approach with preservation of the fat.

The fat should be transposed into the top of the cheek.  Doing this it is improbable that you will need fat grafted into the eyelid.  You should not have a skin incision because despite the magical thinking of surgeons this will harm the position of the lower eyelid.  Study the before and after picture cited below.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower lid blepharoplasty

From these photos, you would do well with a lower lid transconjunctival fat repositioning surgery.  The fat would be moved down into the tear trough to smooth out the area.  You should have plenty of fat for this, so would not need to take fat from another area to transfer. Your skin looks pretty good.  If you have some excess,it can be removed with a pinch of skin, or tightened with some laser resurfacing.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Lower Lid bag remival

There's no substitute for a physical examination but you appear to be s perfect candidate for an "inside" lid or Transconjunctival incision with fat bag reduction. Then, should there be residual skin excess it can be removed with a "pinch" blepharoplasty. 
Dr. Peter A. Aldea
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Incision for Blepharoplasty

You appear to have very little excess skin which would be consistent with your age. You, therefore, need very little skin excision. Therefore, either of the two procedures you described should give you excellent and comparable results in expert hands. Neither has, apparently, suggested fat removal which is good. You do not, however, appear to need added fat from the abdomen, as transposition of the lower lid fat should be adequate.. The transconjunctival method may have a slight edge as far as safety with a slightly decreased chance of drooping of the lateral lower eyelid, but that is about the only other difference. 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Transconjunctival vs transcutaneous

I agree with many of the comments below. You do not have that much redundant skin in your lower kids thus a trams conjunctival approach with some fat removal and some redraping over the year trough would be nice for you. 

Taha Shipchandler, MD
Indianapolis Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Lower eyelid fat bulge

If you don't have a lot of loose skin, a transconjunctival blepharoplasty with fat repositioning may be just the right procedure.Don't shop the procedure or the price, look for the best doctor to do your procedure.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Outside or inside incision for lower eyelid surgery

Most times an inside and outside incision are used. What is more important is what happens through this incision, especially the outside incision. In most cases, it is preferable to remove fat from the inside incision. This avoids disturbing important tissue planes that can scar and pull the lower lid down.  An outside incision may be necessary to remove excess skin, but not always. When done correctly, just the excess skin is taken and the muscles that support the lower lid remain.  This will rarely if ever cause adverse lower lid scarring. A very careful dissection through the lower lid from the outside to the fat pads can be done, but it has a greater risk and it is almost impossible to know which patient will tolerate this approach.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews


Hello and thank you for your question. Based on your photograph, you are a great candidate for a lower eyelid blepharoplasty with a transconjunctival approach to remove some fat with no external incisions.  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.  The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 124 reviews

Outer or inert incision for lower eyelids

Since you are so young, you have very good lower eyelid tone and you have virtually no sun damage.  All you have is some puffiness under the eyes caused by some pseudo herniated fat and maybe one or two millimeters of excess skin.  This makes you a perfect candidate for a transconjunctival (inside the eye incision) Blepharoplasty and after removal of excess fat you have some excess skin a simple pinch excision of the skin can be performed and you would have an excellent permanent result.  I would definitely not perform your lower Blepharoplasty through an external incision.

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