Eyelid Surgery: Cost, Photos, Rewiews, Q&A

Transconjunctival blepharoplasty procedure is one technique for shaping the lower eyelid. it involves making an incision on the inside of the lower eyelid – and altering the shape of the fat of the lower eyelid. There may be other eyelid adjustments that are made at the same time. As you age the lower eyelid muscle and tendon tend to loosen and the tranconjunctival approach only is ususally not enough to rejuvenate the eyelid shape. ( Trevor M. Born, MD , Toronto Plastic Surgeon)

Transconjunctival lower blepharoplasty procedure the preferred lower eyelid surgery

The “best” procedure for you very much depends on what your issues are. Many patients who come to see me for transconjunctival blepharoplasty procedure do great just with lower eyelid volume with under eye Restylane.

Surgery can be appropriate and the issue is then which of the eyelid surgeries are right for your particular situation. Transconjunctival lower eyelid surgery has become the preferred approach for addressing herniated orbital fat.

Often this is modified to preserve the lower eyelid fat as a pedicle graft that is rotated into the top of the cheek to reduce the groove that is often present in the lower eyelid.

If there is significant lower eyelid wrinkles, these can be addressed by the removal of a pinch of skin just below the lower eyelid lashes or a chemical peel.

Prior to the introduction and popularization of transconjunctival lower blepharoplasty, this surgery was primarily done through a lower eyelid incision made just below the lower eyelid lashes.

To access the lower eyelid fat, the incision needed to be made not just through the skin but also through the lower eyelid muscle, the orbicularis oculi. Once the fat was removed, the surgeon often also removed “excess” lower eyelid skin.

Unfortunately, this procedure often permanently damages the lower eyelid muscle and the scar tissue that develops can pull the lower eyelid down. Unfortunately some still persist in performing this type of surgery.

What do you need? This requires a personal consultation with an eyelid specialist to answer definitively. ( Kenneth D. Steinsapir, MD , Los Angeles Oculoplastic Surgeon)

Transconjunctival blepharoplasty procedure image

If you do not have excess skin and only have fat – then the TC bleph is a good way of avoiding a scar on the outside. The lid is flipped down and the fat is removed from the inside. It works well. ( William B. Rosenblatt, MD , New York Plastic Surgeon)

The tansconjunctival or “no visible incision” eyelid tuck (blepharoplasty)

Transconjunctival refers to an approach to the lower eyelid fat collections. It goes on the backside (the conjunctval surface) of the eyelid rather than the skin surface of the eyelid. Since the incision is not visible it is often called the “no visible incision” eyelid tuck. It is traditionally used in people, usually younger individuals, who do not need correction of excess or lax skin but do need correction of prominent lower eyelid fat. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)

Transconjuctival blepharoplasty for eyelid lift surgery

Transconjuctival blepharoplasty is one method to perform lower eyelid plastic surgery. A small incision is made on the inside or pink surface of the lower eyelid. There are no visible external incisions. Excess fat which contributes to baggy eyelids can be removed or altered with this cosmetic approach. Excess skin, however, is not removed from the lower eyelid. Transconjuctival blepharoplasty procedure may help many patients. Generally, patients who are younger or who have already had transconjunctival blepharoplasty procedure previously are candidates for this eyelid plastic surgery. Transconjuctival blepharoplasty may be combined with a chemical peel to help smooth facial wrinkles. Speak with a plastic surgeon who performs transconjunctival blepharoplasty procedure to determine if the transconjuctival approach is better for you than a traditional eyelift surgery. ( Houtan Chaboki, MD , Washington DC Facial Plastic Surgeon)

Transconjunctival Bleharoplasty in some cases

Transconjunctival blepharoplasty procedure is a technique that allows the surgeon to access your eye lid fat compartments and remove the fat or to redrap it over the bony part of the fat.

This is an excellent technique with no external scarring, however, it would not work alone if you have excess skin or sagging eye lids.

A ” pinch ” skin excision could be done for minor cases, otherwise a formal blepharoplasty will need to be done. ( Hisham Seify, MD, PhD, FACS , Orange County Plastic Surgeon)

Transconjunctival blepharoplasty purpose

Procedures should service the goal. Some can be substituted for another but others perform different functions. If you need to have skin removed, transconjunctival blepharoplasty is not a substitute for skin inicision blepharoplasty.

It’s main benefit is to remove periorbital fat from the lower lid without a visible incision on the skin. If fat removal is the sole goal, then it accomplishes this with less complications and quicker recovery and no skin incision.

A surgeon can also utilize thisapproach to place cheek implants and reposition the fat. ( Robin T.W. Yuan, MD , Beverly Hills Plastic Surgeon)

A transconjunctival blepharoplasty involves an incision inside the eyelid. It is typically most appropriate for a patient with little excess lower eyelid skin, and it can be used to address herniated fat.

The location of the incision avoids an external scar, and there is a decreased chance of lower lid laxity. For certain patients, I will sometimes perform this procedure in conjunction with a lower eyelid resurfacing for a nice result. ( Ryan Greene, MD, PhD , )

A transconjunctival blepharoplasty is a technique that allows for prominent fat (bags) removal and not excess skin.

The incision is made on inside surface of the lower eyelid, through the conjunctiva (transconjunctivally) to reach the fat.

If necessary the transconjunctival approach also allows for re-positioning of fat to fill in hollow areas of the lower eyelid.

This technique can be combined with skin removal from the eyelid using an incision just below the lashes. It is the perfect procedure to use with laser eyelid re-surfacing.

One should remember this technique is not useful in all situations. ( Adam J. Cohen, MD , Skokie Oculoplastic Surgeon)

Transconjunctival Lower Blepharoplasty

The transconjunctival approach for lower eyelid surgery involves making an incision on the inside of the eyelid for removal of the fat pads that typically cause the puffiness of the lids.

It is a great technique for some patients because there is no external scar. However, it is just one option for the surgery, and it may not be the best for every patient.

I would encourage your discussing this with your plastic surgeon. However, it is usually better to focus on the overall surgery, the experience of the doctor, and your comfort level, as opposed to advocating one technique over the other. Michael Vincent, MD, FACS ( Michael Vincent, MD , Rockville Plastic Surgeon)

What is Transconjunctival Blepharoplasty?

This is a type of eyelid surgery in which an incision is made on the inner surface of the eyelid rather than the skin. The obvious advantage is no external scar. However, for someone with heavy bags and less skin elasticity (we lose elasticity as we age) removing the fat bags may leave behind droopy skin. In these individuals, an external incision is beneficial because it allows removal of excess, lax skin and removal of thick eyelid muscle that may be contributing to the problem. ( Anand D. Patel, MD , Orlando Plastic Surgeon)

Transconjunctival blepharoplasty

A transconjunctival blepharoplasty refers to the placement of the incision for the surgery on the inside of the eyelid.

Advantages of this approach include lower incidence of post-op lid retraction, no external visible scar, and decreased OR time.

It is a great option for removal of the bags under your eyes, and can be combined with other procedures to improve the quality of the overlying skin, such as chemical peels and laser, as well as various fillers to improve the transition of your lower lids to your cheek. ( Mark Ginsburg, DO , Fort Lauderdale Facial Plastic Surgeon)

Transconjunctival blepharoplasty

There are 2 ways to approach the fat pads in the lower eyelids.

1. Through the skin – with an incision just below the eyelashes
2. Through the conjunctival surface on the backside of the eyelid.

Which one is best depends on the patient’s situation. If someone has great looking eyelid skin, but just a little isolated fat pad which bulges, then a transconjunctival approach can work nicely, without a visible external scar. ( Thomas Fiala, MD , Media Facial Plastic Surgeon)

When do you do a transconjuctival blepharoplasty

Transconjuctival blepharoplasty is limited to the lower eyelids and usually to younger patients who do not have excess fat. The lining of the lower eyelid is conjuctiva.

Young people may have large fat deposits in the lower eyelids without excess skin. An incision in the sulcus of the lower eyelid will give access to these fat compartments ( there are three) and can be easily removed. Most patients over forty cannot take advantage of this technique. ( Gary H. Manchester, MD (retired) , San Diego Plastic Surgeon)

Transconjunctival blepharoplasty incisionless surgery for lower eyelids

An excellent approach to removing excess lower eyelid fat which can cause puffiness is via the transconjunctival approach. In this method, lower eyelid fat that is in excess is removed between the lower eyelid on the inside and the eye itself. By removing fat in this way, a scar can be avoided. In addition, this approach offers an excellent way to improve the hollowness in the nasojugal groove or tear trough where the fat can be repositioned to that area again without a scar. Finally, if there is a small amount of loose skin or wrinkling this can be addressed the same time with a chemical peel or laser resurfacing. (Scott Trimas, MD, Jacksonville Facial Plastic Surgeon)

Transconjunctival lower eyelid blepharoplasty

A transconjunctival blepharoplasty involves an incision on the inside of your eyelid and allows the surgeon to remove fat or reposition it. More often than not, with increasing age, the transconjunctival approach needs to add an external incision to remove excess skin or tighten the muscle. (Ankit Desai, MD, Jacksonville Plastic Surgeon)

Transconjunctival blepharoplasty, technique to remove fat from lower lids

Transconjunctival blepharoplasty has been around for over twenty years. It is a technique to simply remove fat, underneath the lower lids whereby an incision is made at the subconjunctival area on the inside of the lower lid, and the fat is removed out of the three compartments in the lower lid.

We use the trans-conjunctival approach for fat removal exclusively in our practice. The fat compartments in the lower lid are what create puffiness and bags, causing a tired look. This needs to be done under general anesthesia because of the pain associated with teasing fat out from the orbital septum.

The reason that trans-conjunctival approach is very popular is because it alleviates the need to transect the muscle which was performed on older techniques from the outside approach. Transecting the muscle from an outside approach can lead to a scleral show or pull down affect of the lateral portion of the lower eyelid and give a sad eye appearance. There is only minimal mild pain after the surgery. For many examples of eyelid surgery, please see the link below (William Portuese, MD, Seattle Facial Plastic Surgeon)

Transconjunctival blepharoplasty avoids a visible scar and does not change eyelid shape

Transconjunctival blepharoplasty is done through a tiny incision on the inside of the eyelid through the pink part of the lower eyelid. Traditional blepharoplasty is done through a visible incision on the outside of the lower eyelid. The visible scar is not the only problem with the traditional blepharoplasty incision.

Because the incision goes through the muscle and supporting structures of the lower eyelid, the shape of the eyelid is often changed and the lower eyelid droops down into a sad eyed look or “hound dog eyes.” Because the transconjunctival incision does not cut through the support structure, normal eyelid shape is preserved. (Brooke R. Seckel, MD, FACS, Boston Plastic Surgeon)

Transconjunctival Blepharoplasty – An approach to the fat

A Blepharoplasty is any operation around the eyeball that improves the external cosmetic appearance. Often we divide the operation into upper lid surgery (Upper Blepharoplasty), and lower lid surgery (Lower Blepharoplasty).

When you look at lower eyelid aging, you can divide it into several different components: Skin, Muscle, Fat, and attachments to deeper structures. Transconjunctival just refers to an approach [a place to make a cut.

Literally: Trans (thru) the conjunctiva (the mucosa inside the eyelid).] It allows the surgeon to remove / reposition the fat, and release some of the attachments. If a patient only has fat excess making their lower lids look old, then a transconj belph will work very nicely and has low risk. If you have skin excess, then other approaches are needed as well (such as a peel or even skin excision). Your surgeon may still use the transconjunctival approach to address the fat, but you might require a scar on the outside of the lid to remove excess skin. Don’t go shopping for a particular named procedure – rather visit with a surgeon who specializes in eyelid surgery, discuss what you would like to improve upon, and listen to their plan on how to achieve your goal. (Michael A. Bogdan, MD, FACS, Dallas Plastic Surgeon)