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 .

What's the difference between a browlift and a blepharoplasty? Which do you need?

This is a very frequent question in my practice. Maybe my patient saw something on TV or spoke with a friend but they're convinced that they need a specific procedure to rejuvenate their face. This is incredibly common when talking about the eyes and upper face and there is alot of confusion out there.

What is a browlift?

Women tend to have refined, arched eyebrows which sit above the bony rim of the eye socket. Men, on the other hand, tend to have flat eyebrows with minimal arch and their brows tend to sit right on top of the framework of the eye socket. The browlift procedure is designed to lift and reshape the eyebrows. 

Does the browlift procedure differ in women vs. men?

The procedure is technically the same. However, I aim for a refined, arched brow in women and a flatter, less elevated brow in men to maintain the natural cues of a feminine or masculine face. One major mistake for men seeking brow or eyelid surgery is undergoing a procedure with a plastic surgeon who does not frequently operate on men. The result is often a feminized appearance that clashes with the rest of the man's masculine appearance.

What is a blepharoplasty?

Both upper and lower blepharoplasty are frequently performed. This is the most common procedure performed in my practice for women and men. 

An upper blepharoplasty is performed to remove extra skin from the upper eyelid, a small strip of muscle and occasionally a pocket of fat near the nose. This recreates the natural eyelid crease and "opens" the eyes making a person look more rested and more youthful.

Lower blepharoplasty most often involves removing fat that forms a "bag" or a bulge in the lower eyelid. This is typically performed with an incision hidden on the back of the eyelid. In patients with extra skin in the lower eyelid, a small incision is placed below the eyelashes to remove the extra skin.

So which do I need?

Drooping eyebrows AND extra upper eyelid
skin require both a blepharoplasty and browlift.

• If your eyebrows are drooping AND there is extra skin in the upper eyelid when the brow is lifted to its natural position, you need a browlift AND a blepharoplasty.

Drooping eyebrows but NO extra upper eyelid
skin require a browlift only. 

• If your eyebrows droop but there is no extra skin in the upper eyelid when the brow is lifted to its natural position, you need a browlift only. 

Eyebrows in good position but extra upper
eyelid skin require a blepharoplasty. 

• If your eyebrows are in good position but your upper eyelids are full, you need an upper blepharoplasty.

How can I learn more?

Setup a complimentary consultation with me to discuss browlift, blepharoplasty or any aspect of facial rejuvenation surgery. You can reach my office at (303) 788-6632. For your convenience, I have office hours on Wednesday evenings and Saturdays available.