Three Different Approaches to Lower Eyelid Surgery

Cosmetic surgery for bulging lower eyelids is based around two traditional approaches and one approach much newer. Fat can be removed from within an incision made either on the front surface of the eyelid (the transcutaneous approach) or on its inside or back surface (the transconjunctival approach). More recently, procedures have been devised that allow for lower bulging to be treated without removing fat.

1. Transcutaneous Lower Blepharoplasty

Popular since the 1950s, this version of lower blepharoplasty is based upon a skin incision made just below the lashes and extending most of the way across the eyelid and then slightly past the outer corner. From there, the dissection is carried into the eyelid's interior, where, depending upon the patient's findings, the rest of operation occurs.

2. Transconjunctival Lower Blepharoplasty

Popular since the 1980s, this version of lower blepharoplasty is based upon an incision made on the inside lining of the eyelid known as the conjunctiva. The dissection is then carried into the orbit to remove extra fat.

3. Tissue-Sparing Lower Blepharoplasty

The reason fat can create bulging in the lower eyelid is only rarely because it has grown excessive. Instead, an internal hernia allows orbital fat to push forward against a weakened orbital septum. By repairing the hernia, the fat can be returned to its natural position inside the orbit instead of needing to be removed, thus greatly decreasing the risk of both immediate and long-term hollowness.

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Several adjunctive procedures can be used to enhance the outcome of these procedures. Operations like canthopexy, skin strip excision, and laser and chemical skin resurfacing can be undertaken to address secondary problems like skin excess, wrinkling, or a diminished structural support system.

When seeking cosmetic lower eyelid surgery, it's a mistake to think of these operations as equal with respect to safety, recovery time, and immediate and long-term outcomes. Why so? Because they aren't.