1. Almost No Possibility of Scar-Related Lower Eyelid Retraction
The risk of internal scar-related lower eyelid retraction (an abnormal pulling down of the lid to expose the 'white' of the eyeball) is all but eliminated when transconjunctival lower blepharoplasty is used to trim bulging orbital fat. Since the operation does not violate the important but delicate middle layer of the eyelid, the negative consequences of contracture from deep scarring either immediately after or even years later do not develop.
If a transconjunctival approach is employed to do more than trim orbital fat (for instance, fat repositioning into a cheek hollow or placement of a tear trough or cheek implant), the dissection needed is much more extensive. Some (although still small) risk of internal scar-related retraction is then reintroduced.
Can lower eyelid "retraction" occur for reasons other than scarring inside the lid? Yes. Although rarely mentioned in discussions on blepharoplasty, if too much orbital fat is removed by any method, the eyelid may lose its support from below and collapse downward into the resulting hollow.
2. Increased Precision
Because the eyelid is not "taken apart" from the front, it is easier for the surgeon to gauge the effect of fat removal as the operation is in progress. What results is a more accurate assessment of the amount of fat to be trimmed and increased precision.
Is it still possible to over or under resect fat? Of course. Employing a safer approach is only one variable in the whole operation.
3. More Rapid Recovery
Because the transconjunctival approach is less invasive, there is generally less bruising and swelling (not none at all, but rather much less than with other operations).
4. More Natural Appearing Outcome
As noted previously, one of the most feared complications of lower blepharoplasty is eyelid retraction, a complication that is by no means rare with the full transcutaneous approach. Even if this does not present in full bloom, the eyelid is not uncommonly rounded and left less mobile.
With the transconjunctival approach, such internal scar-related problems do not occur.
5. No Visible Scar Extending Across Most of the Eyelid
If there is no skin incision extending from one side of the lid to the other, there's no corresponding external scar.
Still, the procedure is not a "no-scar operation," as it is sometimes misrepresented. There will always be a scar after any incision. With transconjunctival surgery, that scar is located on the inside surface of the lower eyelid where it is neither visible to others, able to be felt, nor a source of problems for the eyelid or eyeball.
If transconjunctival surgery is coupled with canthopexy, skin-only excision, and/or other external procedures, a scar will, of course, be created by these other operations. Is this bad? If the other procedures are indicated but not done, the final result will be less than optimal.
While certainly nice, patients tend to make too much out of the hidden scar advantage. Far more substantial benefits of this operation are noted above.
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