Lower Blepharoplasty Eyelid Surgery
Ventura, Los Angeles, Santa Barbara

Transconjunctival and Tissue-Sparing
Lower Blepharoplasty

Transconjunctival

• The eyeball is protected by a plastic plate. The lower eyelid is retracted down and away from the eye. The initial incision is made by sweeping an electric current across the inside surface of the eyelid (conjunctiva).

• A step-wise conservative removal of fat is undertaken from one, two, or all three of the fat pads, thereby sculpting the lid into its new shape.

• Care is taken to leave some of the lid's fullness intact, as a hollowed eyelid suggests aging or illness rather than youth.

Several options for treating loose or damaged skin may be considered along with transconjunctival lower blepharoplasty:

• Wrinkles may be softened, skin quality improved, and the skin tightened slightly by the application of trichloroacetic acid (TCA chemical peel) immediately following the surgery.

• When indicated, a tiny strip of skin may be pinched and removed from the area just below the lashes (stitches are then necessary) without disturbing the deeper eyelid structure.

• When indicated, thinned or sagging tissues supporting the lower eyelid may be tightened (canthopexy) by attaching them to bone or fascia surrounding the socket.

Tissue-Sparing

Alternatively, bulging orbital fat to be returned to its normal anatomic compartment, making fat removal unnecessary. There are numerous advantages to tissue-sparing lower blepharoplasty, which is a newer technique.

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While still in wide use, transcutaneous lower blepharoplasty (the full operation undertaken through a skin incision) had not been employed in our practice for over fifteen years. Not only is the aesthetic outcome sub-optimal, but the risk of significant immediate and late complications is unacceptably high.

Although still popular, we refrain from lower eyelid fat repositioning into the tear trough in the vast majority of patients. Less invasive, safer, and more effective approaches are available for filling upper cheek hollows. Moving substantial amounts of fat out of the orbit simply to camouflage a cheek depression introduces the possibility of causing eyelid hollowness.

Anesthesia > Upper Lids > Brows > Lower Lids

From the Insider's Guide to Blepharoplasty
Chapter 17: Transconjunctival lower blepharoplasty
Chapter 18: Skin-approach lower blepharoplasty
Chapter 19: Canthoplasty, canthopexy, lateral canthal tightening
Chapter 20: Lower eyelid fat repositioning
Chapter 21: Cheek, midface, and SOOF lift surgery
Chapter 22: Skin resurfacing: Chemical and laser
Chatper 30: Treatment of lower blepharoplasty complications

From The Hollowed Eyelid
The Most Common Surgical Missteps

From Eyelid Surgery Photos
Before-and-After Blepharoplasty Patient Photos

From Eyelid Surgery Operations
Lower Blepharoplasty Photographed Step-by-Step

From Eyelid Surgery QuickNotes
Two Basic But Very Different Approaches to Lower Blepharoplasty
Should Skin Ever Be Removed From the Lower Eyelid?

From the Asian Eyelid Surgery Resource
Lower Eyelid Asian Blepharoplasty