Lower Transconjunctival Blepharoplasty
Lower transconjunctival blepharoplasty is a wonderful procedure for the lower eyelid because it is very safe and protects the lower eyelid muscle.
It is fairly simple and works well to remove the fat “bags” of the lower eyelid. Transconjunctival means the incision to approach these fat “bags” is made on the inside of the eyelid.
Often, I will combine this with a “skin pinch” technique to remove extra skin on the outside of the lid. Doing this can help avoid a “pulled down” or sad appearance to the eyelid post operative.
The lower eyelid is a delicate structure and very important to approach with care. Be sure to consult with a board certified surgeon. ( Paul Watterson, MD , Columbus Facial Plastic Surgeon)
What is a lower transconjunctival blepharoplasty
The goal of lower eyelid blepharoplasty, for many people is removing the bags under the eyes. Often the bags are caused primarily by prominent lower eyelid fat.
It is possible to remove this fat by an incision through the skin (transcutaneous approach) or from the inside of the eyelid (transconjunctival approach).
When performed by an experience surgeon, the transconjunctival approach (from the inside of the eyelid) is the safest and has the fastest healing time.
The issue is that the transconjunctival approach does not remove any skin. For the majority of patients that is fine. However, for some people, skin removal is needed.
See a good cosmetic surgeon and they can explain the pros and cons of each of these surgeries in the context of your particular anatomy. ( Marc Cohen, MD , Philadelphia Oculoplastic Surgeon)
Transconj blepharoplasty
Lower transconjunctival blepharoplasties have been performed for 2 decades with excellent results. The incision is made on the inner aspect of the eyelid and fat is either removed or repositioned.
The advantage theoretically is that the orbital septum is kept intact thus minimizing post-operative lower eyelid retraction (transconjunctival bleeps only apply to the lower lids). Many patients require skin removal and thus a skin incision may also be required. ( Rand Rodgers, MD , New York Oculoplastic Surgeon)
Transconjunctival Lower Eyelid Surgery
A lower transconjunctival blepharoplasty will avoid having scar on the outside of your eyelid. The best candidate is someone with minimal bulging of the periorbital fat and no wrinkles on the lower eyelid. If you have significant amount of loose/wrinkle skin on your lower eyelids you are better off having a conventional transcutaneous blepharoplasty.
The incisions on the eyelids heal very well and is not noticeable. The shape of your eyes could also be rejuvenated with this technique which is not possible with a transconjunctival lower blepharoplasty. Procedures around your eye require an additional set of surgical skills and knowledge and the best thing you can do is to do your research and find a surgeon with specialized training in the periorbital region. ( Jose Rodríguez-Feliz, MD , West Palm Beach Plastic Surgeon)
Transconjunctival Blepharoplasty
A surgeon can utilize transconjuctival Blepharoplasty to remove of the excess fat of the lower eyelids. In this approach, the incision is placed inside the eyelid. The transconjuctival Blepharoplasty reduces the risk of eyelid rounding or ectropion (where the eyelids pulls down and away from the eyeball).
As with any procedure, a patient must be an appropriate candidate for it. Consult with 3 experienced and expert board certified plastic surgeons to understand your options. ( Kris M. Reddy, MD, FACS , Chicago Plastic Surgeon)
What is a Transconjunctival Blepharoplasty?
Lower transconjunctival blepharoplasty is a technical term that describes an eyelift done through an incision on the inside of the eyelid. You can treat the under eye bag through this approach but you can’t tighten the skin and muscle so the results are not as dramatic as an eyelift performed through an incision on the outside under the eyelash (what I think you are calling a traditional blepharoplasty). It all depends on your goal from the procedure and your surgeon’s comfort level. Many surgeons prefer the transconjunctival approach because it is easier and less demanding than the skin muscle or “traditional” approach. ( Mohammed Alghoul, MD , Charlotte Plastic Surgeon)
What is a transconjunctival lower blepharoplasty
A transconjunctival lower blepharoplasty, or TCB, is where an incision is made inside of the lower eyelid and the fat pockets are either removed or repositioned to make the puffy appearance look better.
There is no skin incision and no skin removed, so typically it is done on a small percentage of patients, those that have no skin issues.
If one needs skin removed, a traditional lower Blepharoplasty can be done but some surgeons will combine a TCB with a skin pinch skin removal of the lower lid. (Julio Garcia, MD, Las Vegas Plastic Surgeon)
Finesse in Transconjunctival lower blepharoplasty
A transconjunctival lower blepharoplasty is useful only in patients who have no redundant skin, but who have some slight fullness in the lower eyelid.
This is uncommon in patients over the age of 40. However, it works well in patients who do have slight bulging with no redundant skin. I use it in conjunction with my 5-step blepharoplasty in which I preserve the orbicularis oculi muscle, which is very important, to minimize complications.
In conclusion, a transconjunctival blepharoplasty is a very useful adjunctive technique for blepharoplasty if there is no redundant skin. (Rod J. Rohrich, MD, Dallas Plastic Surgeon)
T-C or not T-C, that is the question.
Transconj implies the incision will be made on the inside of the lower lid and gives access to fat and some other maneuvers, this is commonly paired with laser to manage excess skin. To be honest this was the rage 10 years ago and has recently been resurrected as a “safe alternative” to regular blepharoplasty. In truth, the anatomy drives the proper procedure, not the desire of the pt or comfort of the surgeon. So see a good surgeon and decide, together. (Rafael C. Cabrera, MD, Boca Raton Plastic Surgeon)
Transconjuctival lower blepharoplasty avoids muscle injury
The eyelid muscles are delicate. The less that is done to them the better. If the surgeon can remove the fat from the inside of the lid (without touching the muscle) and the skin from the outside of the lid (without touching the muscle), trauma is less and recovery is faster. It is an excellent operation that I do now almost exclusively. (Mark B. Constantian, MD, FACS, Nashua Plastic Surgeon)
Transconjunctival lower eyelid surgery
The palpebral conjunctiva is the pink membrane on the underside of your eyelid. Transconjunctival lower blepharoplasty is a procedure to remove or reposition fat from the lower eyelid by making an incision through this area rather than an external incision just below the lashes which is where a standard blepharoplasty incision is made.
The standard incision heals very well and inconspicuous. Transconjunctival blepahroplasty is appropriate for patients who do not have a significant amount of excess lower lid skin and mostly have a fat bulge.
If there is excess skin, then either skin pinch with transconjunctival lower blepharoplasty or traditional blepharoplasty may be appropriate depending on the amount of excess skin to be removed (skin pinch is not good for large amount of skin to be removed).
See a facial specialist who can evaluate your eyelids and let you know the best option for your individual anatomy. (Sirius K. Yoo, MD, San Diego Facial Plastic Surgeon)
Transconjunctival blepharoplasty
With a transconjunctival blepharoplasty the incision is made on the inside of the lower eyelid and the scar is not noticed. You may reduce or re-position the fats bags with this technique but no skin may be removed through this incision. The advantage is no scar and decreased chance of lower eyelid malposition compared with external skin approaches. It may be combined with skin resurfacing to tighten the skin and remove wrinkles. If there is excess skin, you may still require an external incision to remove it. ( Donald Nunn, MD , Atlanta Plastic Surgeon)
Transconjunctival vs subciliary blepharoplasty
Lower eyelid surgery can be either transconjunctival, meaning the incision is inside the eyelid, or subciliary, meaning the incision is just below the lower lashes.
Choosing the best approach depends on the patient and exactly what is needed to get the best result.
In a patient with good skin elasticity and lower lid bags just from the fat, a transconjunctival approach allows the surgeon to remove the fat without an external incision or disrupting any of the supporting structures.
However, in a patient with excess skin as well as extra fat, a subciliary approach allows the surgeon to address both the extra skin and fat.
An experienced surgeon will reconstruct the support structures in the lower lid making the complication rates with either approach not appreciably different.
The incision is just below the lower lashes and tends to heal very well. It can often be covered with makeup at 7-10 days. ( Angela Sturm, MD , Houston Facial Plastic Surgeon)
Transconjunctival Eyelid Surgery
A lower lid blepharoplasty can either be done through an incision just underneath the eyelashes or by making an incision on the inside of the eyelid.
If you pull your lower eyelid away from the eyeball you can see the pink inner lining of the eyelid. This inner lining is the conjunctiva.
An incision can be made through this lining to remove or to reposition unwanted fat causing bulging of the lower eyelid. However, this incision does not allow for any removal of excess skin of the lower eyelid nor does it allow for any other procedures which may be necessary to tighten the lower eyelid.
In order for you to have the best outcome, it is very important to select a well-trained plastic surgeon skilled and experienced in the performance of all types of eyelid surgery. ( John J. Edney, MD , Omaha Plastic Surgeon)
Transconjunctival vs. Skin-Muscle Flap Approach for Lower Eyelids
There are a variety of approaches to lower eyelid surgery, but the two most common are the transconjunctival and the skin-muscle flap. The former involves making an incision on the inside of the eyelid (the conjunctiva) and then generally removing fat pockets. The benefit of this approach is typically a somewhat faster recovery with less bruising and swelling.
The downside is that it is a bit limited – for example, if you have extra skin and muscle, these are not removed through a transconjunctival approach. Lastly, in a skin-muscle flap, the surgeon can use the extra fat to smooth out the lower eyelid-cheek region by repositioning the fat pockets. In certain patients, this approach may be preferred. ( Evan Ransom, MD , Bay Area Facial Plastic Surgeon)
Transconjunctival Blepharoplasty, Advantages?
The transconjunctival approach leaves the muscle layer intact. This helps to support the lid and reduce the chance of complications. The approach is one where you pull down the lower lid, (like when you were frightening the girls in 3rd grade).
One then goes in that way to take out the excess fat. Now if one wants to , they can take excess skin from under the lower lid, but still keep the muscle layer intact. ( Jeffrey Roth, MD , Las Vegas Plastic Surgeon)
Transconjuctival lower lid blepharoplasty
The trams conjunctival approach is useful primarily in younger patients who have puffy lower lids and no excess skin. Traditional lower lid surgery is better in most cases to remove excess skin as well as fat. The problem I have seen in the transconjuctival approach is that often there is inadequate fat removal.
I feel the approach with external incision works better overall. Some surgeons prefer the transconjuntival technique because they are afraid of the lower lid getting pulled down with the skin removal of the external approach. ( Ronald J. Edelson, MD , San Diego Plastic Surgeon)
The transconjunctival approach refers to a technique used in lower lid blepharoplasty, and is the best for removing fat from the lower eyelids.
The incisions are done inside the lids so that there is no skin incision. ( Patrick Flaharty, MD , Bonita Springs Oculoplastic Surgeon)
The transconjuctival approach is the way I proceed with the majority of my patients who need lower lid blepharoplasty. The incision is made inside the eyelid and leaves no visible scar.
It is an ideal procedure for removing fat from the lower lid while removing no skin.
Some patients may need skin removal addressed due to laxity and excess at which times other common blepharoplasty techniques are used. ( Michael Elam, MD , Orange County Facial Plastic Surgeon)
Transconjunctival lower eyelid blepharoplasty
This procedure allows for the surgical removal of the excess fat of the lower eyelid. The fat can also be repositioned over the cheek bone in this procedure.
The incision is made inside the eyelid which which leaves no visible external scars. ( Edward E. Dickerson, IV, MD , Fayetteville Facial Plastic Surgeon)
A transconjuntival lower eyelid blepharoplasty is one technique used for lower eyelid rejuvination. The incision is placed inside of the eyelid (through the red part) and the fat of the oribt can be addressed.
This approach will not allow for skin removal or tightening. The potential advantage is the scar is hidden but the potential downfall is potential under correction. ( Chad K. Wheeler, MD , Spokane Plastic Surgeon)
Transconjunctival Lower Eyelid Blepharoplasty
A transconjunctival blepharoplasty is a technique to remove lower eyelid fat bags without making a lower eyelid incision on the skin. It is useful in patients with moderate lower fat bags who don’t have extra loose skin.
It is helpful because it avoids cutting the lower eyelid muscle and avoids postop droopiness. If a small amount of skin is needed than a pinch of skin can be removed. ( Paul Vitenas, Jr., MD , Houston Plastic Surgeon)
Approaches to eyelid lift
There are multiple approaches for a lower eyelid blepharoplasty – the two most common approaches are the subcilliary incision and transconjunctival incision.
Transconjunctival incision is basically made on the inner part of the lower eyelid after the eyelid is gently retracted off the globe. The excess fat is then removed. The subcillary incision is placed on the skin just below the eyelashes and the excess fat is removed as well as excess eyelid skin. ( Raj S. Ambay, MD , Tampa Plastic Surgeon)
Tranconjunctival lower eyelid blepharoplasty vs. Subcilliary
Surgeons have two surgical approaches to choose from when addressing lower eyelids:
- Transconjunctival (also called “internal blepharoplasty” or “scarless blepharoplasty”). The internal approach to lower eyelid blepharoplasty involves a fine incision made on the inner surface of the lower eyelid. Because the scars are inside the lower eyelid where they cannot be seen, this procedure is often called scarless blepharoplasty.
- Subcilliary (also called “external blepharoplasty”). The EXTERNAL approach involves an incision that is made just below the lower lash line. The incision fades with time to become virtually imperceptible. Is Transconjunctival Better Than Traditional Eyelid Surgery? 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 but limited skin laxity. If extra skin needs to be removed, then the external approach (subcilliary) is more appropriate. ( Thomas Buonassisi, MD , Vancouver Facial Plastic Surgeon)
What is Transconjunctival lower eyelid blepharoplasty
Transconjunctival (TC) blepharoplasty refers to a lower eyelid blepharoplasty in which the incisions are made on the inside of the eyelid. The advantages to this approach are that there are no external scars and the risk of changing the contour of the lower lid margin is very low.
The disadvantage is that there is no ability to treat excess skin. If the problem is excess fat in the lower lid in the absence of loose skin, this is an excellent approach. ( Andrew B. Denton, MD , Vancouver Facial Plastic Surgeon)