Three Disadvantages of Transconjunctival Lower Blepharoplasty

1. No Skin Can Be Excised

How can baggy skin on the front of the lower eyelid be removed when the operation is being performed entirely from the back surface of the lid. Obviously, it can't be. So, if a patient clearly has excess skin along with too much fat (a very common combo), does this mean the only option is to undergo a transcutaneous approach?

Hardly, even though this so-called "disadvantage" is frequently cited by proponents of the transcutaneous approach. If both fat and skin require excision, the surgeon can simply first employ the transconjunctival approach to most safely trim the fat and then make a second skin-only incision along the front surface of the eyelid to most safely remove any offending skin.

Okay, but then how could making two incisions be better than accessing both skin and fat from within a single incision? It is because it's safer in any number of ways, the most notable of which is that the orbicularis muscle and orbital septum (both crucial for proper eyelid support and function) remain fully preserved.

2. Requires Increased Technical Skill

For a beginning surgeon inexperienced with the transconjunctival approach (or even a seasoned cosmetic specialist who performs only a few blepharoplasties in between breast augmentations), the operation's learning curve can seem daunting if not treacherous.

Manipulating orbital fat from within a tiny opening located between the back of the eyelid and the front of the eyeball may not seem that appealing because it's easy for the uninitiated to get lost.

On the other hand, once the operation had been learned, it really isn't any more difficult to perform than any other. It's like learning the piano. Once you progress past the hunt-and-peck stage and can finally play Chopin, you're now ready focus your energy less on finding the right keys and more on mastering nuances.

3. Yes, the Eyelid Can Be Hollowed

Since transconjunctival blepharoplasty is an operation designed to remove fat, it is, of course, possible to remove too much. Unfortunately, the full negative effect of orbital fat removal may not be fully noted until years after healing.