Choosing Transconjunctival Lower Blepharoplasty - Why It Beats the Transcutaneous Approach
Lower eyelid surgery is a highly popular procedure to address signs of aging in the under-eye area. It targets key concerns like puffiness, bags, and sagging skin. Two primary surgical approaches stand out among physicians: the transconjunctival and the transcutaneous methods. Both options deliver results. However, you may want to opt for the transconjunctival approach. In many cases, it offers key advantages that make it a better choice for natural-looking outcomes with a smoother recovery. At Raleigh Eye & Face, Dr. Mettu focuses exclusively on the transconjunctival approach for his patients.
Here’s why the transconjunctival technique tends to outperform the transcutaneous method:
1. No External Incisions or Visible Scars
The most significant advantage of the transconjunctival approach lies in how it involves no external incisions. Instead, Dr. Mettu makes a small incision inside the lower eyelid (through the conjunctiva). This internal access point then allows removal of fat deposits without cutting through the skin or muscle.
The transcutaneous method requires an incision just below the lower lash line. Even with careful suturing, there is a small risk of visible scarring with this external approach. The risk increases in patients prone to poor scarring or with delicate or thinner skin.
The transconjunctival method is the clear winner in terms of scarring.
2. Lower Risk of Lower Eyelid Retraction
Lower eyelid retraction involves the eyelid being pulled downward after surgery. This is a well-known complication of transcutaneous blepharoplasty. This risk arises because the external approach disrupts more tissue layers. These layers include the skin and the orbicularis oculi muscle, which helps support the eyelid.
Transconjunctival blepharoplasty involves the surgeon leaving the supporting structures of the lower eyelid intact. Doing so dramatically reduces the chance of eyelid malposition or retraction. Patients are less likely to develop complications, including scleral show (excess white of the eye exposed) and a rounded eye appearance after surgery.
3. Faster Healing and Less Downtime
Since the transconjunctival method involves less tissue trauma and no external stitches, healing tends to be faster and easier compared to the transcutaneous approach.
Patients typically experience:
Reduced swelling and bruising
Little discomfort
Rapid return to normal activities
This can be especially appealing for individuals who want to minimize visible signs of recent surgery or who have busy lifestyles.
4. Ideal for Fat Removal
One of the main goals of lower blepharoplasty is to address under-eye bags caused by herniated fat pads. The transconjunctival approach offers direct, precise access to these fat pads, making it highly effective for conservative fat removal.
Surgeons today favor fat preservation rather than simply excising fat, as this helps maintain youthful fullness and avoid a hollowed-out look. The transconjunctival approach facilitates this modern technique beautifully, allowing natural contouring of the under-eye area.
5. Better for Younger Patients and Those Without Skin Laxity
For patients whose primary concern is fat herniation without significant skin excess, the transconjunctival approach is usually ideal. This is often the case for younger patients or those with good skin elasticity.
In these cases, removing the fat from inside the eyelid achieves a refreshed look without the need to cut and tighten skin externally — thereby avoiding unnecessary risks.
When Is Transcutaneous Still Appropriate?
There are certain cases where the transcutaneous method may still be warranted — such as patients with substantial skin laxity or significant lower eyelid wrinkles requiring skin tightening. In such cases, combining skin removal with a muscle-sparing technique can produce the best result.
However, most patients seeking lower eyelid rejuvenation with a natural appearance and minimal risk will find ideal results with the transconjunctival approach.
Optimal Benefits in Multiple Ways
Choosing the right surgical technique for lower blepharoplasty depends on your anatomy, goals, and the surgeon’s expertise. That said, the transconjunctival method offers a long list of advantages:
Less risk of complications like eyelid retraction
Faster healing
Superior fat sculpting
Ideal for patients without excess skin
Book With Dr. Mettu
Consult with board-certified oculofacial surgeon Dr. Mettu in Raleigh, who specializes in eyelid surgery for patients of all ages. In many cases, you may find that transconjunctival lower blepharoplasty is the safest and most advanced way to achieve youthful, natural-looking results.
