Expert Doctor

Transconjunctival Blepharoplasty

The eye area is one of the many places that show immediate physical changes associated with aging. As we age, the area under the eye starts to have loose, wrinkled skin and can have protruding excess fat which results in unsightly bulges. This problem can be addressed by a procedure called blepharoplasty. Blepharoplasty is one of the most commonly performed cosmetic procedures today. It is also one of the most challenging as it requires a thorough knowledge and understanding of the anatomy of the eye area.

There are two general types of blepharoplasty. The first one is the more traditional transcutaneous blepharoplasty while the other one is known as transconjunctival blepharoplasty. Both are discussed in this article but greater emphasis will be given to transconjunctival blepharoplasty, which is the relatively newer technique.



Both transconjunctival and transcutaneous blepharoplasty are cosmetic procedures that aim to rejuvenate and improve the appearance of the lower eyelids. With the transcutaneous method, the doctor creates an incision through the skin at the edge of the eyelids to remove the excess fat underneath. It may also require the removal of some redundant muscle and loose skin.

Transconjunctival, on the other hand, is performed through an incision in the eyelashes on the conjunctiva. The conjunctiva is the pink tissue that lines the inside surface of the eyelids. Rather than making an incision on the skin, which most practitioners do, the transconjunctival method is done on the other side. As a result, there will be no visible scars because there are no external incisions.  

Transconjunctival blepharoplasty is a procedure designed to remove, reposition, or redistribute herniated fat in the lower eyelids. But it works well only if the under eye area has a minimal amounts of excess skin. Basically, it is for patients who want rejuvenation of the eyelids but do not really have a lot of extra skin.

According to studies, this technique is particularly useful for younger patients who have minimal excess fat and do not need skin excision. But further evidences suggest that it is also suited for older patients if they have mild-to-moderate skin laxity.



Complications that may arise from transcutaneous blepharoplasty include scarring and malposition of the lower eyelids. Performing transconjunctival blepharoplasty can minimize the occurrence of these complications. Even though transconjunctival blepharoplasty has its own complications. That is why the transconjunctival method is considered a good alternative to its transcutaneous counterpart.

The main advantage of transconjunctival blepharoplasty over other traditional eye lift is that there is no external incision. This means no scars will be visible, because the scarring will be inside.



Patients must take note that transconjunctival blepharoplasty alone will not get rid of loose skin and fine lines. For these problems, other treatment options may be needed. For instance, removal of fine lines often requires simultaneous treatment with laser resurfacing to peel away the dead cells of the skin. If there is a lot of loose skin, patients are advised to undergo transcutaneous, instead of transconjunctival, blepharoplasty as it allows the removal of both herniated fat and loose skin.



The average cost of transconjunctival blepharoplasty primarily depends on the training and expertise of the surgeon that will perform it. In general, the cost will probably be anywhere from $3,000 to $5,000 in the United States.



Transconjunctival blepharoplasty can always address problems of herniated fat by taking it out, repositioning it or adding some more fat. What cannot be done through the procedure is the simultaneous removal of extra skin, smoothing wrinkles, or lifting the corner of the eyelid. All of these problems require other treatments like chemical peels and laser resurfacing or a transcutaneous approach. Tightening up the corner of the eyelid due to aging, or from a prior surgery, is best managed by another type of eyelid surgery known as canthopexy.

Side effects include bruising and swelling for the first few days. Using ointments and eye drops can treat Chemosis, or the inflammation of the conjunctiva. Steroid medications may also be prescribed according to the degree of inflammation. If Chemosis occurs, it is important to remember than any potential irritants like contact lenses (if the patient is using one) should be avoided as much as possible.

One serious side effect of blepharoplasty is uncontrolled bleeding from the site where the excess fats were taken. This can lead to severe pain, bulging of the eyeball, and decreased vision. Any severe and persistent eye pain should be considered an emergency and must be evaluated by a doctor. This may require hospitalization to control bleeding and administer appropriate medications.

With regards to long-term side effects, there is none so long as the procedure is done properly. There may be scarring but it will be very minimal. With transcutaneous blepharoplasty, the patient may also have problems with opening or closing the eye especially if too much skin has been taken away.



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 steril 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 transconjunctival blepharoplasty.



Results of transconjunctival blepharoplasty can be seen after a few days when the tissues have started to heal. There will be further improvements once the healing is completed which typically happens months after the procedure. For this reason, further surgeries should be avoided for at least 2 months.



Most practitioners would agree that even with the development of the transconjunctival technique, blepharoplasty still remains one of the most technically difficult cosmetic surgeries to perform. Patients should seek a surgeon who specializes in this procedure and not a cosmetic surgeon who occasionally does it. Be sure to choose one that has the required knowledge, skills, training, and experience. 


Written by Cosmetic Town Editorial Team - AA

Based on an exclusive interview with Dr. Alan Matarasso in New York, NY