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What is Transconjunctival Lower Eyelid Blepharoplasty?

20 Oct

A blepharoplasty is an operation on the eyelid that improves the external cosmetic appearance. In this blog I’ll discuss what is transconjunctival blepharoplasty and how it can rejuvenate your look.

Often plastic surgeons classify blepharoplasty into upper lid surgery (upper blepharoplasty), and lower lid surgery (lower blepharoplasty). When performing lower eyelid surgery (lower blepharoplasty) plastic surgeons have two surgical approaches to choose from: transconjunctival (also called "internal blepharoplasty" or "scarless blepharoplasty"), and transcutaneous (also called "external blepharoplasty").

What exactly is transconjunctival blepharoplasty?

The transconjunctival approach to lower eyelid blepharoplasty involves a precise incision made on the inner lining  of the lower eyelid (the conjunctival surface) rather than the outer skin surface of the eyelid. Because the scars are inside the lower eyelid where they cannot be seen, this procedure is often called “scarless blepharoplasty”. In addition, the transconjunctival incision does not cut through support structures so normal eyelid shape is preserved.

What does a transconjunctival blepharoplasty address?

The approach allows the surgeon to remove the fat in the lower eyelid ‘eye bags’ or under eye bulges. Occasionally, removal of fat is not the principal goal. Instead, repositioning of the eyelid fat may be more appropriate to address any contour irregularities and blend the lower eyelid and cheek junction. Repositioning rather than removing the fat is often preferable as it avoids a hollowed out, older appearance, and is an excellent way to address the problem of tear troughs.

If a patient only has excess fat (under eye bags) making their lower eye area look old, then a transconjunctival belpharoplasty will work very nicely and be low risk. If there is excess skin, then other approaches are needed as well. These may include a "skin pinch" excision on the outside of the eyelid without going through muscle and connective tissue layers. This technique does leave an external incision just below the lashes but heals remarkably well and is barely visible in 6 to 12 weeks.  Chemical peel or laser resurfacing may also be used along with transconjunctival blepharoplasty to address fine eyelid skin wrinkles.  

What is transcutaneous or external blepharoplasty?

This approach involves a skin incision made just below the lower eyelid lash line. It is the preferred approach for excessive loose skin and wrinkles along the lower eyelids or if the muscle needs to be significantly tightened. For someone with eye bags and less skin elasticity (we lose elasticity as we age), removing the fat bags may leave behind droopy skin. In this case, an external incision is beneficial because it removes excess, lax skin and  thickend eyelid muscle that may be contributing to the problem.

Which approach is right for you?

The most appropriate approach for each patient depends on their age and lower eyelid features. The internal approach is typically appropriate for younger patients who have bulging lower eyelids or eyebags but minimal loose skin. If extra skin needs to be removed, then the external approach (transcutaneous) is more appropriate.

It is advisable to keep an open mind when considering eyelid surgery. Avoid shopping for a particular named procedure; rather, consult with a plastic surgeon who specialises in eyelid surgery, discuss what you would like to improve upon, and listen to his or her plan on how to achieve your goal.

If you need additional information to assist you in deciding whether cosmetic surgery is the right option for you, send me a quick email at info@naveensomia.com.au and I will happily assist you.

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Topics: Eyelids
Dr Naveen Somia MBBS, PhD, FRACS

Written by Dr Naveen Somia MBBS, PhD, FRACS

Dr. Naveen Somia is a Sydney Plastic Surgeon who listens to his patients, understands their problems and works alongside them to help achieve their aesthetic goals by applying his skills and years of experience in Plastic and Cosmetic Surgery. A published author on Plastic and Cosmetic Surgery, Naveen’s blog is aimed at helping you make the right choices and stay safe in your quest to look your personal best.