Transconjunctival vs. Transcutaneous Blepharoplasty: What Does All This Mean and Which is Right for You?

First off, what is a blepharoplasty?

Blepharoplasty, or an eyelid "lift", is one of the most common facial plastic surgery procedures performed worldwide. Both the upper and lower eyelids can be "lifted" but I'll focus on the lowers in this post. Lower blepharoplasty most often involves removing a "bag" or bulge of fat from the lower eyelid and, in some cases, removing extra skin from the lower eyelid as well. 

Before transcutaneous lower blepharoplasty.

After transcutaneous lower blepharoplasty.

What are the alternatives to lower blepharoplasty?

The options are few. However, lower eyelid bags can be camouflaged (not removed but covered up) with injectable filler such as Juvederm or Restylane. This should last somewhere between 6-12 months and must be repeated to maintain the effect. Extra lower eyelid skin can also be treated with CO2 laser resurfacing to tighten rather than remove the extra skin. This is a long-lasting result but is less robust than surgically removing that crepey skin.

What is the difference between a transconjunctival and transcutaneous blepharoplasty?

Transconjunctival means "through the conjunctiva" or pink tissue on the back of the eyelid. Transconjunctival blepharoplasty involves a small incision hidden on the backside of the lower eyelid. The fat pockets are visualized and the fat is either conservatively removed or rearranged to eliminate the bag. The incision heals very nicely and should not cause any problems with lower eyelid position if performed by an experienced plastic surgeon. This approach does not remove or tighten the lower eyelid skin. To achieve this a small amount of skin is removed via a separate skin incision under the eyelashes ("skin pinch") or the lower eyelid skin can be resurfaced with the CO2 laser at the same time.

Transcutaneous means "through the skin." Transcutaneous blepharoplasty is performed through a single incision just below the eyelashes. This same incision can be used to remove the lower eyelid bag and tighten the lower eyelid skin. For this reason, it is much more straight-forward to perform the transcutaneous approach. Many patients are concerned about the appearance of an incision in this location. I can tell you it heals very, very well. In fact, I've had several patients ask why I didn't make the incision in this area at their one week post-surgery appointment. I did.... They just couldn't see it, even one week after surgery.

So which is better?

These two approaches to blepharoplasty are just tools. If performed properly in an appropriately selected patient, they are both highly effective. A consultation is required to discuss the option, surgical or non-surgical, that is most appropriate for you.

To schedule a consultation you can reach my office at (303) 788-6632 or email info@lonetreefacial.com .