Transconjunctival vs. Transcutaneous Blepharoplasty

Thank you for your question.

The main benefit of Transconjunctival Blepharoplasty over traditional Blepharoplasty with External Incision is that the support of the lower eyelid is maintained. External Eyelid Incision Blepharoplasty can damage the lower Eyelid support and result in a pull down or sag of the lower eyelid. This can be a very serious complication and in fact change in Eyelid Shape is the most common complication of traditional Lower Eyelid Blepharoplasty.

Another advantage of the Transconjunctival Approach is no visible scar on the Eyelid.

If loose skin is a problem after Fat Removal a small "skin pinch" can be done through a skin only incision in the outside corner of the eye and the lid can be tightened.

Hello,For a person of your age the primary goal is to remove fat from the lower eyelid that is causing the puffiness. There are two basic ways to get to this fat, one is through the inside of the lower eyelid, the second is through the skin of the lower eyelid. The difference between these approaches is important. If the incision is made on the inside of the eyelid the muscle that surrounds and supports the eyelid is not injured in any way.This helps to prevent any change in the position of the lower eyelid as you are healing from surgery. In your case you probably would not need to have any excess skin removed from the lower eyelid. If skin were needed to be removed that would occur through a second incision on the outside of the eyelid just below the eyelashes. This would still allow the underlying muscle to remain intact. As you can tell I would favor the trans-conjunctival (inside of the eyelid) approach.

In someone such as yourself with significant lower eyelid bags but no skin excess, a transconjunctival blepharoplasty will give nice results.  You would additionally benefit from an arcus marginalis release performed thru the trans-conj incision.  The release will soften the junction between the lower eyelid and cheek skin (the tear trough), and further reduce the "tired eye" baggy appearance.  Lower lid procedures that do not involve skin removal or tightening carry a lower risk for ectropion / dry eyes, so can be thought of as being safer.
Dr. B