What’s the Best Form of Eyelid Surgery?
There are two main techniques for lower eyelid surgery, transconjunctival and transcutaneous. These are complicated terms used to describe relatively simple approaches: from behind the lash line (through the conjunctiva) or below the lash line (through the skin).
Which of these two methods is best?
Transconjunctival blepharoplasty has an obvious benefit patients are quick to grasp—it leaves no visible traces of surgery. Another advantage plastic surgeons sometimes mention is that it keeps instruments further away from key facial muscles, thereby lowering the risk of ectropion, or eyelid sagging.
Through small incisions inside the lower lids, fat pads can be removed to eliminate chronically puffy eyes. Transconjunctival blepharoplasty can be a valid choice for the occasional patient with fat bags and great skin quality.
The transconjunctival method does have limits. One is that most patients have loose skin that can’t be treated from behind the lashes. This is the very reason fat deposits under the eyes become apparent with age: lax skin no longer holds them in check. If skin needs to be eliminated, the transcutaneous approach is the way to go.
In addition, many plastic surgeons are moving away from eliminating fat under the eyes. Recognizing that a hollowed appearance adds to an aged look, the strategy for most patients today is to reposition fat rather than remove it. This can often best be done through transcutaneous incisions, and in fact it reduces the number of occasions that call for transconjunctival blepharoplasty.
Utilizing a transcutaneous approach, an experienced plastic surgeon can not only eliminate loose, wrinkly eyelid skin and reposition fat, he or she can give a lift to the entire mid face area if experienced in such a procedure. This technique is sometimes referred to as a mid facelift or an extended eyelid tuck. Thus, the transcutaneous form of eyelid surgery is much more versatile than the transconjunctival route.
The key to reducing the risk of eyelid surgery, no matter which approach is used, is to choose your plastic surgeon wisely. When you work a board certified plastic or oculoplastic surgeon with excellent training and hundreds of blepharoplasty procedures to his or her credit, risks will be very small indeed.
Take some time to learn about other options for refreshing the lower lid area as well. To treat fine wrinkles or dark circles, a chemical peel may be the solution. Fillers such as Restylane® and Juvederm® can plump tear troughs as needed. The delicate skin around the eyes often benefits from combination treatments.
Learning about blepharoplasty and cosmetic treatments for the eyelid area is a good investment of your time. When you arrange consultations to discuss your appearance, you will be equipped to consider the wisdom of the recommendations you hear. Make sure your plastic surgeon has an extensive toolkit and many before and after photos that show good results. Together you will make the right calls.
