Transconjunctival vs Transcutaneous Blepharoplasty | Lower Eyelid Surgery Explained

Added: 2026-05-21

[00:00:00]Here's what I hate about transcutaneous lower lid blepharoplasty.

[00:00:05]It can pull the eyelid down. What does that mean? There are three layers to the lower eyelid that we're treating when we're doing surgery. There's a layer of skin, then there's a layer of muscle right underneath there, and then there's the deeper fats that we need to manipulate when we're doing surgery.

[00:00:20]Often times surgeons will cut through the skin with an incision and then cut through the muscle of the lower eyelid to get to the deepest layer of fats. But every time you're cutting through that muscle layer here, you're increasing the risk of pulling the eyelid down cuz you're affecting the tone of that muscle. So for my surgeries, I never touch that muscle layer. We don't want to manipulate it. We don't want to cut it because that can have consequential effects of pulling the eyelid down.

[00:00:48]So, how do we do it? We treat the deepest layer, this fat layer, with something called a transconjunctival blepharoplasty. We don't go through the skin, we don't go through the muscle, we go from inside the eyelid, find these little pockets of fat, and remove them or drape them down. Then if we need to treat the skin, we just make an incision on the skin, but sparing the muscle underneath, and just trim off a little excess skin. So we've treated the skin layer, we've treated the fat layer, but we've left the middle layer of muscle all alone. And by doing that, we've really protected your eyelid from any pull down or ectropion. That is a key to beautiful surgical results with little complication.