Transconjunctival Blepharoplasty

Excerpt

Transconjunctival blepharoplasty is the management of lower eyelid structures via the conjunctival approach and is usually applied to the cosmetic improvement of the lower eyelid using this approach. The transconjunctival approach is often also used for reconstructive surgery. The very essence of this surgical procedure implies that there is no skin incision made when addressing the deeper structures of orbital fat, ligaments, and orbital septum. However, at times, some degree of skin and tendon manipulation may be necessary during transconjunctival blepharoplasty. The reasons for specific manipulations in the transconjunctival blepharoplasty is also discussed.

Types of Transconjunctival Blepharoplasty

1. Pure transconjunctival blepharoplasty

2. Transconjunctival blepharoplasty with lateral canthal tightening with a canthopexy or canthoplasty

3. Transconjunctival blepharoplasty with lateral canthal tightening and skin pinch excision

4. Transconjunctival blepharoplasty with the release of the orbitomalar ligament and fat transposition or grafting, lateral canthal tightening, with or without skin excision

5. Transconjunctival blepharoplasty with skin-muscle flap (infrequently performed now, but there are exceptional cases where this approach is indicated)

6. Transconjunctival blepharoplasty with midfacial tissue repositioning via a temporal incision (what we have designed and termed the "hammock lift").

In all of the above procedures, chemical peels, erbium or CO₂ laser, broadband light therapy, or any other skin ablation modality may improve skin laxity, irregularities, wrinkles, and lesions. This topic concentrates on the indications, assessment, marking, and performing the pure transconjunctival blepharoplasty.