Background: 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. Aim and objectives: The study aimed to evaluate and compare the aesthetic result for residual fine wrinkles after transconjunctival lower eyelid blepharoplasty alone or combined with post-operative fractional CO2 laser. Subjects and methods: The present study was carried out on 20 patients with lower eyelid puffiness without skin redundancy just fine wrinkles who were selected from patients that were admitted to department of plastic and reconstructive surgery, AL-Azhar University hospitals. Results: Skin tightening and residual wrinkles improvement in group (A) show that 9(90.0%) were improved and 1(10.0%) were not improved while in group (B) 6(60.0%) were not improved and 4(40.0%) were worsen. There was highly statistically significant differences between groups where P<0.001 with better result in group (A) in comparing with group (B). Conclusion: Our results demonstrated that both lower eyelid transconjunctival blepharoplasty alone or with combination with postoperative fractional CO2 laser were safe and effective in the treatment of lower eyelid puffiness. Both of the investigated methods had comparable outcomes in terms of complications and satisfaction.