Transconjuctival lower blepharoplasty or transcutaneous? I'd prefer no scar! (Photo)
Doctor Answers 11
What is better for lower lid surgery?
Trans-conjunctival lower blepharoplasty candidate
Excess skin of lower eyelids
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Transconjuctival vs Transcutaneous - Which One Is Better?
When fat is removed and nothing is done to replace the degenerated septum orbitale which has been holding the fat back all these years, what will happen is either the fat will start coming forward and in a few months to years, it will look like the surgery was not done sufficiently or, if more fat than necessary was removed, then you get the hollowed out look which is very unattractive.
A transcutaneous excision with removal of skin and minimal fat will allow the tightening of the skin and muscle, and then a muscle sling from the lower lid to the upper lateral orbital rim will allow the fat to be pushed backwards replacing the septum orbitale with a tightened obicularis muscle.
For years, I did transconjunctival fat removal with no external scar. The results were never of the same quality as transcutaneous lower lid bleph surgery.
This is a very sophisticated surgery first described by Malcolm Paul M.D. of Newport Beach, California. It has been my experience that even poor surgeons rarely, if ever, get scars on lower eyelids because the dermis is so thin on eyelids, and the thinner the dermis, the finer the scar.
Lower eyelid surgery with no scar
Transconjunctival lower blepharoplasty is ideal method
Transconjunctival lid surgery
Based on your desires, I would proceed with a fat preservation lower lid bleph through the transconjunctival approach. The fat will redrape over the rim and soften the tear trough, elimating the bags.
Transconjunctival vs transcutaneous lower bleph
Several factors go into the decision of which type of blepharoplasty to perform.
1) should the fat be removed or repositioned
2) will the skin need some type of tightening procedure, such as surgical excision or laser, or can it be left alone to shrink on its own
3) will you need a lid tightening procedure, i.e. do you have a positive or negative vector?
As you continue your research, ask these questions of the surgeons you visit. It will help you understand your situation better. Based on your photo, I would probably suggest the transcutaneous approach, with repositioning of the fat, a gentle "lift" of the mid face, and a conservative removal of skin. I wish you the best!
Transconjuctival lower blepharoplasty or transcutaneous?
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