A traditional blepharoplasty or eyelid tightening removes the bags from around the eyes by removing the excess skin and fat. Some patients are candidates for lower lid blepharoplasty through an incision on the inside of the lower eyelid. This is called a transconjunctival blepharoplasty.
The main advantage is that there are no external scars. This is especially helpful for men who cannot use makeup and for those who have a tendency to form thick scars. Another advantage is the reduced risk of ectropion or pulling down of the lower eyelid after surgery. Although excess skin is not removed ectropion can occur because the capsulopalpebral fascia (a thin layer of tissue beneath the lining of the eye) is divided.
Patients who have large amounts of loose skin are not usually candidates and need removal of skin in the usual way. This applies to most elderly patients, although a transconjunctival blepharoplasty is increasingly used even for this group of patients.
The operation is done under either local or general anesthetic and unlike traditional lower lid blepharoplasty can be combined with resurfacing the skin.
The length of time to recover is about the same but the amount of bruising and swelling may be less. Complications are similar. From the surgical perspective the main advantage is that the orbital septum, a fine layer which separates the tissues of the bony orbit from the eyelid tissue, does not have to be divided. This reduces the risks of surgery.