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Transconjunctival Blepharoplasty

transconjunctival blepharoplasty eyelid.

Lower eyelid eye bag surgery with no skin scar

Transconjunctival blepharoplasty is a relatively newer technique of performing eyelid surgery to the lower eyelidBlepharoplasty is the eyelid surgery done to address the eye loose wrinkled skin and protuding excess fat that causes bulges to the eyelid.  It is a more challenging technique that requires a comprehensive knowledge of the anatomy of the lower eyelid and upper cheek in order to be performed correctly The more traditional approach is the transcutaneous approach which leaves a small scar hidden in the lower eyelashes. This traditional approach is more useful for people who have excess skin that also needs to be removed at the same time. 



Transconjunctival and transcutaneous blepharoplasty are both different approaches to eyelid surgery which aims to improve the appearance and rejuvenate the lower eyelids. An eyelid skin incision is created in the transcutaneous approach to remove or redraw the excess fat underneath and sometimes to remove any excess muscle and skin.  With the transconjunctival approach, the incision is hidden on the inner surface of the eyelid so that the skin is left without any scar. The procedure is is used to remove or reposition any of the excess fat in the lower eyelids and to soften the lower eyelid wrinkle that is commonly known as the tear trough. This only works well when there is only a minimal amount of excess skin that does not require removal.  As a result it is useful in younger patients with a small amount of excess fat and do not need any skin removal as well as old patients with minimal laxity in their skin where the aim of the surgery is just to correct the bulging or tear trough caused by the excess fat.



Transcutaneous blepharoplasty limitations include  a scar that usually hides under the lower eyelid lashes and malposition of the lower eyelids. Having a conjunctival blepharoplasty can reduce the risk of these complications occurring. Transconjunctival blepharoplasty is also not without risk however and can have its own complications.  The main advantage of the conjunctival blepharoplasty is there is no external incision and so there are no visible scars on the eyelid following the procedure.



Transconjunctival blepharoplasty on its own will not treat the skin and remove any of the excess skin and fine wrinkles. For the excess skin and fine wrinkles, other treatments may be needed such as laser resurfacing to peel away the dead cells of the skin. If there is a lot of excess skin however, the transconjunctival approach is not recommended and a transcutaneous approach is more suitable with can remove the excess skin as well as treat the underlying excess fat.



We work on a fully open and transparent pricing model so that you are aware of all the costs involved before proceeding with your treatment. For a complete list of prices including blepharoplasty costs please visit our prices page.



Transconjunctival blepharoplasty can always address problems of bulging fat by taking it out or repositioning it. As there is no surgery performed on the skin the procedure limitations include being unable to remove the extra skin, smoothing any fine wrinkles on the skin or lifting the outer corner of the eyelid.  To correct these issues other treatments are required such as a chemical peel to the skin, laser skin resurfacing or a transcutaneous approach to the surgery and Mr Ahmad Aziz can advise you on what is most suitable during your consultation at the Central London eye clinics in and around Harley Street.   

Canthopexy is the procedure that helps to tightening the corner of the eyelid that can become lax with time or from prior Tightening up the corner of the eyelid due to ageing, or from a prior surgery, is best managed by another type of eyelid surgery known as canthopexy.

Side effects of the surgery including eyelid swelling and bruising for the first week. The use of contact lenses immediately following the surgery should be avoided to allow the incision not he inside of the eyelid to heal. A serious side of effect of this approach to the surgery is bleeding from the site where the extra fat has been removed. This can cause pain. the eyeball to protrude forward and decreased vision. If there are any of these signs following the surgery you need to see your ophthalmologist urgently. As with all eyelid surgery the eyelid itself does continue to age with time and over the years raging changes may begin to show again.



After the surgery, the patient is advised to keep his head and upper body elevated for the first few days (particularly when sleeping). This helps the bruising and swelling around the eye to subside. A sterile strip will also be applied to the lower lids to keep them suspended and to provide pressure while healing. The strip can be kept in place for 2 to 3 days or until the inflammation of the lower conjunctiva is gone. Cold compresses may also be used to assist in the relief of bruising and swelling for the first 24 to 48 hours. Aside from inflammation, the patient’s vision will be slightly blurry for the first 24 hours due to the ointment that the practitioner will put onto the eyes.

Patients can have ointments, antibiotics and pain medication as needed. Massaging of the treated area must be done periodically in order to promote faster healing. The recovery period is about 5 to 6 days. After that period, the patient can put on a bit of makeup and go back to work without anybody knowing they underwent Conjunctival blepharoplasty.



Results of can be seen after a few days when the eyelid starts to heal although there will still be some significant swelling.. There will be further improvements over the following 2 months as the swelling settles and the eyelid recovers. . For this reason, further surgery to the lower eyelids should be avoided for at least 2 months.



Most oculoplastic surgeons would say that blepharoplasty to the lower eyelid still remains one of the most technically difficult types of eyelid surgery to perform. Patients should seek an oculoplastic surgeon who is very familiar with this procedure and not a cosmetic surgeon who occasionally does it. Be sure to choose  an oculoplastic surgeon who has trained in the area around the eye to ensure that they have the knowledge, training and experience to give you the best possible outcome.

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