Transconjunctival Lower Blepharoplasty

What is Transconjunctival Lower Blepharoplasty?

Transconjunctival lower blepharoplasty is a surgical technique in which the lower eyelid fat compartments are accessed through an incision made on the inner surface of the lower eyelid, the conjunctiva, rather than through an external skin incision. The fat can then be removed or repositioned through this internal access point, leaving no visible scar on the outer eyelid skin.

The technique is well established and widely regarded as the preferred approach for patients with fat prolapse but good lower eyelid skin tone.

How Does It Work?

• A small incision is made on the inner surface of the lower eyelid, through the conjunctiva and the lower eyelid retractors
• The three fat compartments of the lower eyelid are identified and accessed
• Fat is either removed carefully or repositioned over the orbital rim to fill the tear trough
• The conjunctival incision heals without sutures in most cases, or with a single dissolving suture
• No incision is made on the external skin surface

The Three Lower Eyelid Fat Compartments

One of the keys to a natural result in transconjunctival blepharoplasty is understanding and independently addressing all three fat compartments.

Fat Compartment

Location

Common Appearance When Prolapsed

Medial (nasal)

Inner corner of the lower eyelid

Puffiness near the nose, often most prominent

Central

Middle of the lower eyelid

Central bag beneath the eye

Lateral

Outer corner of the lower eyelid

Fullness toward the outer eye, sometimes subtle

Each compartment is assessed individually and treated according to how much it is contributing to the overall appearance.

The Surgical Tools Used

There are two primary surgical routes for accessing the lower eyelid, each suited to different presentations.

What to Expect: Recovery Week by Week

Days 1 to 3: Immediate Recovery

• Bruising and swelling around the eyes, though often less than with the transcutaneous approach
• Cold compresses help manage bruising
• Eye drops or lubricating ointment may be recommended for comfort
• Head elevation during sleep reduces swelling

Days 4 to 7: Early Progress

• Bruising begins to fade and swelling reduces noticeably
• No sutures to remove in most cases, simplifying early recovery
• Most patients feel comfortable at home and able to carry out daily tasks

Week 2: Returning to Normal

• Most patients return to work and light social activities during this period
• Makeup can be worn around the eyes from approximately day ten
• The lower eyelid area continues to settle and improve

Weeks 3 to 4: Resuming Daily Life

• Light exercise can be reintroduced
• The lower eyelid feels natural and the improvement in puffiness is clearly visible
• Any residual chemosis of the conjunctiva resolves

Months 2 to 4: Final Results

• Full resolution of swelling is complete
• The improvement in lower eyelid contour is clearly established
• With no external scar, there is no scar maturation to wait for

Clinical Outcomes: What to Expect Long Term

• Longevity: Results are stable for ten or more years as fat does not regrow once removed
• Scar outcomes: The absence of an external scar is the most significant clinical advantage of this approach
• Natural appearance: When fat is repositioned rather than removed, the result avoids the hollowed appearance that can follow aggressive excision
• Conjunctival healing: The conjunctival incision heals quickly and completely, with no long-term effect on eye comfort or health in the vast majority of patients

Potential Risks and Considerations

Common and Temporary

• Bruising and swelling around the eyes
• Temporary dry eye symptoms or increased tear production
• Chemosis, a swelling of the conjunctiva, which typically resolves within two to four weeks

Less Common Risks

• Under-correction if fat removal is too conservative
• Over-correction producing a hollowed appearance if too much fat is removed
• Temporary blurring of vision from lubricating ointment

Rare Risks

• Persistent chemosis requiring treatment
• Damage to the inferior oblique muscle, which runs between the fat compartments, causing temporary double vision
• Haematoma within the orbit, which is extremely rare but requires prompt assessment

Financial Considerations

• Eye drops and lubricating ointment during recovery
• Time off work, typically one to two weeks
• Follow-up appointments to assess fat reduction and eyelid position

The transconjunctival approach is the gold standard for lower blepharoplasty in patients with fat prolapse and good skin tone. The absence of an external scar combined with a reliable improvement in lower eyelid contour makes it one of the most elegant techniques in facial surgery.

Want to find out if transconjunctival lower blepharoplasty is suitable for you? Book a consultation to discuss your anatomy and goals.