What Are the Risks of Transconjunctival Lower Eyelid Surgery with Skin Pinch?

All surgery carries some risk; eyelid surgery included. Whether the incision is made in the skin below the lid/lashes or in the conjunctival trough behind the lid margin, there are certain risks that may include unwanted bleeding, scarring, and even problems associated with loss of vision and/or cornea injuries.  But when patients are carefully selected and prepared for surgery (ie, no aspirin containing products for example, and no physical activity post operatively for awhile) this greatly reduces risks. Blepharoplasty is a very delicately performed procedure, and it is important to discuss details with the surgeon whether this is a facial plastic or plastic surgeon or oculoplastic surgeon.  In most cases, the transconjunctival approach to removal or repositioning of lower eyelid fat ('bags") is a nice procedure, and can be combined with outer skin resurfacing (chemical peels or lasers) at the same time. This can lead to a very refreshed appearance with high patient satisfaction!

The risks of this operation are the same as with any blepharoplasty: the risks of the anesthetic, bleeding, infection, dry or teary eyes, injury to the muscles that move your eyes and injury to the eye itself, up to and including blindness. There are also the aesthetic complications: too much, too little, unevenness, etc.

I have done this operation for at least a half-dozen years and have found it to work well. It is nearly impossible to produce the most common complication of all: ectropion, or pulling down of the lower lid.

This is because the operation leaves untouched virtually all the structures that support the lid against the effects of healing and gravity.

I am a big fan of this operation.

Good luck!

 

There should be almost no risk if you go to an experienced plastic surgeon who has done these for many years.

A photograph would be very helpful to meaningfully answer this question.  The particular risk of the surgery really relate to your precise anatomy.  For example, if your issues are such that a filler service is all you actually need then having unnecessary surgery is a complication.  The skin pinch can sometimes be a skin muscle pinch.  The key really relates to the execution of surgery.  General plastic surgeons and facial plastic surgeons do offer these procedures as do oculoplastic surgeons.  The trend has been preservation of fat by moving it from the lower eyelid to the top of the cheek, called an arcus marginalis release.  This reduces the risk of making the lower eyelid too hollow by removing excessive lower eyelid fat.

  The risk of this procedure is, IMHO, the same as the risk for any lower lid eyelid surgery.  There is nothing wrong with this recommendation.  But lower eyelid surgery can be tricky.  You may want to see someone who is a nmember of the American Society of Ophthalmis Plastic and Reconstructive Surgery for an opinion before proceeding.

 The biggest risk of lower eyelid surgery in lower eyelid malposition, or scleral show. If extensive scar tissue builds up around the middle lamella (muscle layer) of the lower eyelid, it's possible for the lower eyelid to be dragged into a lower position, creating a very unnatural appearance. Transconjunctival lower eyelid blepharoplasty minimizes the risks of this, by allowing for fat excision without violating the middle layer of eyelid. I more commonly use laser to tighten the lower eyelid skin, but in patient's with darker skin types, will perform a skin pinch blepharoplasty to redrape the lower eyelid skin.

Hope this helps. Best of luck.

 The primary goal for lower eyelid surgery is to  remove the fatty deposits creating the puffy look to the lower lids. This fat is removed through a trans-conjunctival approach on the inside of the lower lids. For most patients who are over 50 years of age, a small pinch of excess skin is taken at the lash line. In our practice we close  this incision with  tissue glue. For more information  and many before-and-after examples, please see video below

The transconjunctival blepharoplasty is meant for those with bulging fat pads and minimal skin excess. In those cases the remaining skin ideally should contract down and smooth out the area.  If there is excess skin it would need to be removed.  Occasionally laser skin treatments in conjunction with the transconjunctival b;epharoplasty can yield a good result.

For blepharoplasty patients with true lower lid skin excess or redundancy, some skin must be removed to restore a youthful appearance. This is performed through a subciliary incision, which is an incision placed immediately below the lower lid lashes. This incision is hidden by the lower lid eyelashes and is almost always imperceptible once it has healed.

As with upper lid, skin excision of the lower lid should be very conservative, amounting to only that amount of skin that is necessary to improve the lower lid skin contour. The muscle layer below must remain completely undisturbed, as it provides horizontal support for the lower lid and helps to maintain the lid position flush against the surface of the eye. Excessive removal of lower lid skin may lead to a complication called ectropion, where the lower lid is pulled down and away from the surface of the eye. This complication often requires additional surgery to correct it, and must therefore great care must be taken to avoid it.

In eyelid surgery patients that do not have adequate lower lid tone or support, and in any patient felt to be at some risk of ectropion, a lateral canthopexy is performed to protect against that potential problem. The lateral canthus (the lateral corner of the eye) contains a tendon that attaches the lower lid tissues to the orbital rim laterally, and this tendon serves as a 'clothesline' that maintains lower lid position. A lateral canthopexy consists of an anchoring or supporting suture that tightens that tendon and thus the lower lid as well. When desired, a lateral canthopexy can also elevate the position of the lower lid. In patients who desire it, this procedure can produce a more 'almond' shape to the eyes.

Lower Eyelid Fat Pads or "Bags"

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.

As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.

In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.

Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.

From what I understand, fat melting is not really approved nor do I advise. Transconjunctival is removal of the fat.  You have to make sure that you actually need to have lower lid fat removed and make sure that not too much of it is removed. You don’t want to end up having a hollowed out look.  The skin pinch is sometimes done to remove excess skin; but again, you have to make sure it’s really necessary.