Risks of a Second Transconjunctival Blepharoplasty?

I had Transconjunctival blepharoplasty a year and half ago. Left eyelid looks fine, but right one still looks puffy/a bit bulgy. If there's any kind of swelling or fluid retention, it should be resolved at this stage, right? So I suppose there's remaining fat inside. I'm thinking of going for it second time. I just like to know, what's the exact risk I'm taking? I know the risk is much less than external incision approach, still, is there any chance this procedure could cause nerve damage?

Doctor Answers 10

A redo conjunctival blepharoplasty may have slightly increased risk, but not much

A secondary or revision surgery always involves some increased risk compared to the first procedure because healing from the first surgery may change the anatomy slightly. However, in most cases this increased risk is very small, particularly in the hands of an experienced, board certified surgeon. If your first result requires some fine tuning, and your surgeon agrees that he or she can improve on what you have, you should be comfortable having the revision.

Bay Area Plastic Surgeon
4.9 out of 5 stars 54 reviews

Repeat transconjunctival blepharoplasty with caution

Years ago we considered lower lid rejuvenation a 'once-in-a-lifetime' procedure, most often with a standard incision along the lash line. The result was stable and worked well over long periods of time. Today, we often rejuvenate lower lids at an earlier age, and procedures are individualized. The transconjunctival or behind the lid approach allows the removal of inherited fatty bags without the typical blepharoplasty scar. Note though the scar is rarely the issue, however there is no need for it as the skin is not lax and need not be reduced. Transconjunctival blepharoplasty can be repeated, or adjusted if needed. The scar does make the procedure a little more difficult, though the risks are not great.

Now for the caution. The drawback in lower lid rejuvenation, especially repeated procedures, is over reduction of fat with hollowing over time, over removal of skin with poor lid support and loss of shape and pulling (scleral show), dry eyes and inability to close the lid easily. All can lead to an 'operated' look. As you consider revision, also ask about fat grafting under the bag as the bag may be a step off to the cheek. If the bag was 'missed' however you should be able to revise it.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Secondary transconjunctival blepharoplasty

There are occasions when residual fat requires a secondary excision, most often with the lateral compartment. In the absence of any unusual healing or complications such as a hematoma or cicatricial retraction, the risks are similar to the primary surgery. However, sometimes there is a mis-application of the procedure, especially in negative vector type situation, and repeat fat removal can produce an over-resection of the remaining fat.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Transconjunctival blepharoplasty

Besides the inherent risks of eyelid surgery there is also increased scarring second time around and sometimes increased chance of retained fluid swelling. With that said a redo should not be a probem, discuss your concerns with your surgeon.

Robert Schwarcz, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 22 reviews

Secondary transconjunctival blepharoplasty risk

If your left eye looks good , then I would feel comfortable removing the small amount of residual fat left in the right lower eyelid with a transconjunctival blepharoplasty. Nerve risk is minimal. A photo would help!

Burr von Maur, MD
Orange County Plastic Surgeon
4.6 out of 5 stars 22 reviews

Increased risk with second blepharoplasty

There is increased risk with repeated surgeries in the same area. If it is to prominate is there a possibility of making the result more even with the use of fat grafting. Very small amounts can be used around the eyelids to provide a more youthful and beautiful appearance.

Risks of a second transconjunctival blepharoplasty

Before you have an additional procedures performed, it would be best to speak with your surgeon if you feel comfortable, as he/she knows the extent of your surgery and exactly what was performed. It may be retained fat. If you are still not satisfied at that time, it would be best to seek a second opinion. In this case, there is no real risk of nerve damage.  Please feel free to contact me in the future and I would be happy to give you my opinion. Thank you, and best of luck to you.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Lower blepharoplasty

The surgeon should be able to tell if the residual fullness is from fat or other (fluid).  There is no significant risk of undergoing another transconjunctival incision, assuming the residual fullness is fat.  However if fluid/swelling is the problem, any incision can make it worse.

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

Risks of a second transconjunctival blepharoplasty

You should discuss this with your surgeon. There are ALWAYS additional risks when operating upon the same area. I have, personally, done a secondary transconjunctival blepharoplasty after 9 months from the first surgery. The result was great.

From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Transconjunctival blepharoplasty re-do

A secondary blepharoplasty using a transconjunctival approach is certainly ok to perform at 1 to 1 1/2 years post your previous surgery. A "nerve" injury is not very common.

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