Transconjunctival Blepharoplasty Vs Arcus Marginalis Release

Hello, I am a 21-year-old male who definitely wants to have my (minor) eye bags removed. I know they're caused by fat because when I squint or lay on my back they disappear. What would benefit me the most, a transconjunctival blepharoplasty or an arcus marginalis release? What are the differences between the two, and the pros and cons of either? Thank you.


Doctor Answers 17

Arcus marginalis release vs transconjunctival blepharoplasty

Many patients have exactly what you describe, a congenital bulge under the eyes. You have astutely noted that your bulge gets better when you squint; that means the problem is due to a fat bulge. It often looks much better when this fat is removed through a transconjunctival approach.

We have abandoned the arcus marginalis release procedure entirely over 5 years ago. It involves curring and release of the arcus marginalis, in my oipinion a dangerous layer that can contract at the slightest provocation and pull down on the lower eyelid. We would rather place a separate conservative graft in the eye-cheek region than risk this complication.

Besides, why have a complicated procedure when a simple procedure (carefully done by an expert) can give predictable and lasting results?

We have several articles and chapters referenced below on the subject.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 167 reviews

The type of eyelid procedure required depends on your problem

The type of eyelid procedure needs to be be tailored to the patient. As an expert in facial and eyelid procedures, your surgeon should be able to give you the pros and cons of each procedure. I perform the following for the following reasons.

1. Transconjuctival Blepharoplsty - This is a procedure most appropriate for very young patients ( less than 30 ) who have the problem of fat bags but not so much extra skin and wrinkles.

2. Arcus Marginalis Release - This is a procedure most appropriate for patients with deep tear trough and flat anterior cheek descent or who have a very exposed orbital line.

3. Traditional Skin Blepharoplasty - This is the most common procedure and is most appropriate for patients with more skin excess and wrinkles who are over 35 to 40 years of age. With this procedure, I can remove the skin excess as well as remove any fat bulges.

5. Nonsurgical Blepharoplasty - This is a procedure I am performing more commonly. I do this procedure with fillers (Radiesse, Juvederm, or Sculptra). By filling in the malar cheek and camouflaging the orbital bone line, any extra lines get plumped out, the fat bags get camouflaged, and the orbital line is erased.

Phillip Chang, MD
Leesburg Plastic Surgeon
4.5 out of 5 stars 9 reviews

Transconjunctival blepharoplasty vs arcus marginalis release

Generally a 21 year old in my practice can be treated with fillers at your tear trough or transconjunctival fat removal and or with transposition of fat.  I am convinced that a traditional lower lid blepharoplasty which interrupts nerves critical to lower lids function will be replaced by techniques which address budging fat from a transconjuctival approach and skin problems can be corrected with resurfacing or pinch skin only blepharoplasty.  Best to let someone see you and talk to you about your best options.  Good luck

Craig Harrison, MD, PA
Tyler Plastic Surgeon
5.0 out of 5 stars 26 reviews

Transconjunctival blepharoplasty and the arcus marginalis

Transconjunctival blepharoplasty is a technique for exposing the eyelid fat pockets and arcus marginalis without using a skin incision. This technique uses an incision created on the inside of the eyelid through the conjunctiva ( the conjunctiva is the tissue covering the inner surface of the eyelid). Fat is exposed and removed when the eyelid is puffy or fat is re-positioned when the eyelid is hollow. If additional fat is needed to correct eyelid hollowness, then the arcus marginalis can be released. 

The arcus marginalis is a structure that is attached to the eye socket (orbit) bone and helps keep the fat in the eye socket from moving forward. Since we all have fat in our orbit to protect and support the eye, this is a great source for extra fat when needed. When the arcus marginalis is released (incised) fat moves forward and helps to improve hollowness. In the the overwhelming majority of patients no difference in the eyeball position or function occurs.

Adam J. Cohen, MD
Skokie Oculoplastic Surgeon
3.4 out of 5 stars 15 reviews

Transconjunctival blepharoplasty vs arcus marginalis release

The arcus marginalis is usually only released when there are certain preexisting aging conditions of the eyelids where the lower lids have drooped down. The primary goal of lower blepharoplasty surgery is to have the fat pads removed from the lower lids through a transconjunctival approach, which removes the puffy or double bubble look of the lower lids.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 139 reviews

Blepharoplasty vs. arcus marginalis release

Transconjunctival blepharoplasty is performed solely to remove excess or herniated fat that creates the bulging or puffiness of the lower eyelids. If there is excess skin of the lower eyelids, an external skin incision approach is indicated. In my opinion, transconjunctival blepharoplasty is usually indicated in the younger population where there is no skin to remove. However, in a middle aged individual who has multiple rhytids (wrinkles) of the lower lids and puffy fat herniation present with no excess skin to be trimmed, a transconjunctival blepharoplasty can be performed with laser resurfacing of the skin of the lower eyelids. However, there is greater post-op downtime after laser resurfacing.

Sigmund L. Sattenspiel, MD
Freehold Facial Plastic Surgeon

Many factors to consider when deciding which surgery is appropriate

Transconjunctival refers to the type of incision, I assume you are referring to then excising the fat vs an arcus marginalis release where one opens the covering of the bone or perisoteum releasing the area below the fat pad or repositioning the fat pad to that area. Many factors come into play when deciding which surgery is right for you, do you have a midface that is not very prominent (called a negative vector), do you have prominent eyes and others anatomic findings. With that said I more commonly avoid removing fat from someone of your age running the risk of looking hollow in a few years. I would sooner reposition the existing fat or fill the area under the fat for now. There are some patients your age that could benefit from fat debulking. It would all depend on your anatomy.

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

Transconjunctival blepharoplasty easiest way to correct lower eyelid problems

It is very unusual to be 21 and have problems with eyelid bags. If you do have problems with eyelid bags, the easiest way to treat them is to perform the procedure through a transconjunctival approach.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

Transconjunctival blepharoplasty good to remove bags.


1) When people get eyelid bags at a young age, this tends to be a true fat excess which is easily and appropriately removed witha transconjuctival blepharoplasty.

2) In older people, fat should be repositioned instead of removed. This is what the arcus marginalis release ( a more difficult complicated operation) is good for.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Too young for lower lid blepharoplasty for cosmetic reasons

I would start by saying that unless there is a significant familial component to your lower lid fullness, you are too young to be having lower lid blepharoplasty for cosmetic reasons. The transconjunctival approach would be a good approach for blepharoplasty in a younger patient with no lid laxity and fat herniation only. The release of the arcus marginalis would be a necessary step in eyelid rejuvenation surgery if you happen to have significant hollowness of the nasojugal area. Both of the procedures you have mentioned can and are performed concurrently in eyelid rejuvenation.

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.7 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.