Transconjunctival blepharoplasty - the concept of operating on the lower eyelid from the inside of the lid - is a gentle, precise, safe and tissue-sparing procedure for eyelid rejuvenation. Patients contemplating eyelid surgery for eye bags and lower eyelid laxity should consider the benefits associated, as the transconjunctival approach offers several aesthetic and long-term functional advantages compared to traditional techniques.
The anatomy of the eyelids is entirely three-dimensional. Eyelids have an outside (cutis = skin), and an inside (conjunctiva = the inner moist surface of the lid that touches the eye-ball).
In between are three further layers: (1) the thin outer layer of subcutaneous tissue, (2) a middle layer consisting of the flat eye-closure (orbicularis) muscle and connective tissues (orbital septum) which fuses with the cartilage rim (tarsal plate), and (3) the deeper layers that include the orbital fat (which can bulge and cause eye bags).
Open approach versus transconjunctival blepharoplasty
The traditional surgical approach, a ‘trans-cutaneous’ approach (meaning through the skin), allows excellent exposure of the deeper layer and easy surgical correction and restoration, and in addition leaves a minimal scar under the lash line. However, this route requires passing the important central structural layer of the eyelid, which involves disrupting the orbicularis muscle and the eyelid septum and is thus more invasive to the tissues.
The transconjunctival approach has none of these shortcomings, as the eyelid is operated from the inside of the lid. A ‘transconjuctival’ approach (through the conjunctiva) immediately provides access to the deep layers without violating the important central layers of the eyelid. Transconjuctival blepharoplasty can be referred to as ‘tissue-sparing lower blepharoplasty’; ‘muscle-conserving blepharoplasty’, or ‘no-touch blepharoplasty’. Basically, they all refer to the concept of leaving the structural middle-layer of the eyelid intact.
Used primarily for lower eyelid surgeries, transconjunctival blepharoplasty instantly approaches the deep plane and allows very precise adjustments to the orbital fat. For patients with good skin elasticity, a transconjunctival blepharoplasty is the only procedure needed for the successful removal of eye bags.
Patients with a combination of both herniated fat (eye bags) and loose skin will benefit from transconjunctival blepharoplasty. However, to remove the lose skin and/or strengthen the orbicularis muscle necessitates a small additional incision starting below the lashes which allows for both microsurgical skin tightening and muscle restoration. While combining deep layer and superficial layer surgeries, the important middle layer of the eyelid is left untouched.
The personalised blepharoplasty
Transconjunctival blepharoplasty is the key-component in a fully customisable modular approach to aesthetic and functional eyelid surgery. It offers the best method for tailor-made, deep-layer fat manipulation, such as fat removal or fat repositioning.
Other surgical manouevres that work well in parallel with transconjunctival eyelid surgery include: volume enhancing upper eyelid surgeries, tightening of the lower lid (canthopexy) and hollowness treatment of the periorbita and cheek. As the eyelid skin responds well to laser resurfacing and chemical skin peel, our skin specialist frequently collaborates with the intention of improving skin.
Transconjunctival blepharoplasty is performed with TIVA, which involves intravenous sedation. Recovery after transconjunctival blepharoplasty is shorter than traditional eyelid surgery (usually only a few days) and patients generally experience limited bruising and swelling. Transconjunctival blepharoplasty allows a scar-free rejuvenation of the lower lid and has met with a high degree of patient satisfaction. The risk of complications from this procedure is very low.