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Transconjunctival versus Transcutaneous Lower Eyelid Surgery

Published on February 10, 2013

Transconjunctival and transcutaneous lower eyelid surgeries are each a type of lower blepharoplasty, a plastic eyelid surgery that can address a range of issues such as excess fat or “puffiness” around the lower eyelid, loose and wrinkled skin. For great results, your blepharoplasty must be carefully planned by your attending surgeon, who will consider the subtle details of your facial anatomy when determining which type of blepharoplasty is right for you, and details such as whether to remove any fat and where, how tight the eyelid skin should be, and how to achieve natural results for overall facial balance.

Lower eyelid blepharoplasty can be approached either through the skin, transcutaneously, or from behind the eyelid, transconjunctivally. There can be very specific reasons for choosing one approach over another. More commonly, surgeons use a particular approach, not due to inherent advatages of the approach but rather that was they way they were trained. For the most part, tranconjunctival surgery is performed by oculoplastic surgoens who by training are comfortable working near the eye. General plastic surgeons and others lack the specialized training in oculoplastic surgery. They prefer an approach to the eyelid that does not require they to work so close to the eye surface. This is unfortunate because the skin incision usually is made through the underlying muscle. This can damage the function of the underlying muscle, the orbicularis ocli muscle. After surgery, this muscle weakness account for the alteration of the lower eyelid contour that is routine associated with transcutaneous lower eyelid surgery.

Here is an overview of some important features of each surgery type:

Transconjunctival Blepharoplasty

  • Incision made behind the lower eyelid
  • Minimizes the risk of altering the contour of the eyelid margin after surgery
  • Arcus marglinalis release can be performed through the same incision, wherein the eyelid fat is preserved and rotated into the hollow under eyes

Transcutaneous Blepharoplasty

  • Incision made just below the lower eyelid lashes
  • Can possibly damage the function of the orbicularis oculi muscle and affect the lower eyelid contour
  • Permits the removal of excess skin

For some, removal of the lower eyelid fullness from behind the eyelid and removal of excess skin from the front is indicated, via a skin pinch technique or an infracillary incision just below the eyelashes that preserves the underlying muscle. Ultimately, the only way to know what treatment method is right for you is to consult with an experienced oculoplastic surgeon who will meet with you, discuss your concerns and treatment goals, perform a physical examination, and work with you to design an approach that addresses your specific anatomical features and overall facial balance. These are highly complex and specialized procedures that require a skilled and experienced hand, and can bring you many benefits both functional and aesthetic. To schedule a consultation with Dr. Steinsapir, a leading cosmetic eyelid surgeon who practices in Beverly Hills and at UCLA, please call us today.

About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.