Is the Eyelid Approach my Doctor Using Too Aggresive?

I am 30 years old and scheduled for lower eyelid surgery is week. My doctor is using the Transcutaneous Lowerlid Blepharoplasty meathod. He said it is because I have a little bit of excess skin. Do you think given my age this may be too aggressive of an approach? I have had consulations with other doctors who recommended a Transonjunctival Lowerlid Blepharoplasty

Doctor Answers 9

Eyelid Surgery

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Without photos, I cannot comment.  If you are unsure of your surgery, you should consider a second opinion even if it means having to postpone the surgery.  Be sure to consult with a Board Certified Plastic Surgeon to discuss your concerns and expectations.

Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Best Age and Type of Eyelid Surgery

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A transconjunctival approach is used when excess skin does not need to be removed.  This is generally the case for younger patients.  Many factors contribute to aging of the eye area and occasionally skin excess can be seen at younger ages.  Photos and/or an examination would be needed to give you the best assessment.

Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Is the Eyelid Approach my Doctor Using Too Aggressive?

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    If there is a moderate skin laxity then this is the right approach.  If there is mild or no skin laxity then there are better alternatives.   Find a plastic surgeon with ELITE credentials who performs hundreds of eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

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Lower eyelid blepharoplasty

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  For the last 25 years we have used only the trans-conjunctival approach for removal of  the fat pads in the lower lids. The reason that we use a trans-conjunctival approach to prevent weakness of the muscle  which can happen when  a transcutaneous approach is used.  In the  transcutaneous approach the muscle has to be divided to remove the fat. This can result in a lower lid retraction and scleral show. Most patients at age 30 do not need skin removal on  their lower lids.  When patient's are in their 50s and 60s who need skin removal, a conservative pinch technique on the outside of the lids at the  lash line is performed. 2-4 mm of skin is typically removed and then the incision is closed with Histocryl tissue glue. For examples a results of lower blepharoplasty please see our photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Please submit pictures

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The plan for surgery depends on the patient expectation and the extent of the problem. The technique will vary based on many factors and one of the major ones is the surgeons experience. Please send pictures

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Post photos

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It IS a bit unusual for a 30 year old to need skin removed during a blepharoplasty, but not unheard of.

Transconjunctival approaches are bit safer in terms of avoiding postoperative lower eyelid retraction, but in experienced hands transcutaneous approach is also effective, and the incision usually will heal very well.

If you have mild skin excess or crepiness, a mild laser resurfacing might be a good approach, though you skin will be pink for a few weeks.

Again if you post photos, we might be able to give you a better answer.

If you would like a second opinion from an Oculoplastic surgeon, you can find one using the link I've provided below.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Is the Eyelid Approach my Doctor Using Too Aggressive?

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It's impossible to say without reviewing photos of your lower eyelids. Transcutaneous lower blepharoplasty has been associated with higher rates of lower eyelid malposition but this can typically be avoided. If you do have extra lower eyelid skin, the options are to remove it surgically (either via transcutaneous approach or with a "skin pinch" after transconjunctivalunctival lower blepharoplasty) or with laser resurfacing. If you're unsure about the plan, a second opinion will likely help you. I hope this information is helpful.

Stephen Weber MD, FACS

Lone Tree Facial Plastic Surgeon

This is the time to question what your surgeon is doing not after the fact.

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While transcutaneous lower blepharoplasty is a standard lower eyelid surgery approach, it is much more likely to create a problem.  I think for your age it is unlikely that transcutaneous lower blepharoplasty is appropriate.  I would encourage you take yourself of the surgery schedule, get some second opinions, and determine if what is being proposed makes sense or not.  I don't think that a board certified plastic surgeon is the right type of surgeon for an independent opinion as this is the subspecialty that is most drawn to transcutaneous lower blepharoplasty.  Consider facial plastic and oculoplastic specialists as well.

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

Lower Blepharoplasty

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It is impossible to give you advice without examining you (or at least seeing photos).  The transconjunctival blepharoplasty and transcutaneous blepharoplasty are both valid approaches, but some patients may be bettter candidates for one or the other.  If you don't feel comfortable with your surgeon, get a second opinion before your surgery.  I recommend seeing a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery.  You can find one near you at their website,

Michael McCracken, MD
Lone Tree Oculoplastic Surgeon

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.