Lower Blepharoplasty Review, Transcon-junctival vs. Transcutaneous Approach

Abstract

Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags; in our practice this access has become the preferred technique in most of our cases because it is simpler, faster, prevents bad scarring, produces less orbicularis muscle trauma, and decreases postoperative edema and possible retractions (ectropion) in patients with decreased lower palpebral tone. Objective: To identify important concepts when deciding this approach. Material and Methods: Retrospective review of 177 patients who underwent lower blepharoplasty by a single surgical group. Regarding techniques, the transconjunctival approach was selected in 42% of patients while the transcutaneous technique was preferred in 58%. Results: A lower rate of complications was observed by the transconjunctival approach, with greater patient satisfaction. Conclusions: In our experience, due to its simplicity and less traumatic effect on the patient, the transconjunctival approach is an ideal technique, except in cases where there is lower eyelid weakness and surgical resolution is needed.

Comparison of two transconjunctival and transcutaneous approaches in the incidence of scleral show during lower eyelid blepharoplasty

“…These researchers suggested the transconjunctival lower lid blepharoplasty as it circumvents the risk of lower eyelid retraction associated with the transcutaneous approach (Jacono et al 2001). A lower rate of complications reported via the transconjunctival approach, with greater patient satisfaction (Rancati et al 2015).…”

“…The transconjunctival and approaches were preferred in 42 and 58 % (Rancati et al 2015). In transconjunctival versus transcutaneous lower eyelid blepharoplasty (Netscher et al 1995) in 6 months follow-up reported 10 consecutive patients presented for blepharoplasty, and in all patients the transcutaneous subciliary musculocutaneous fl ap approach was used on the left lower eyelid and the transconjunctival preseptal approach was used on the right.…”

Surgical and Non-Surgical Treatment of the Lower Eyelid Fat Bulging Using Lasers and Other Energy-Based Devices

“…Other complications include infection, scleral show, conjunctivitis, corneal ulcer, diplopia, amaurosis, and damage of both the inferior oblique muscle and the orbicularis oculi muscle. According to the results of Rancati et al, 12 insufficient lipectomy is more common in the transconjunctival group than in the transcutaneous blepharoplasty group. On the other hand, overresection of the fat pads frequently results in the hollowing of the infraorbital region along with the worsening of the lower eyelid wrinkles.…”

“…The main risk point is difficulty in bleeding control. 12 Meticulous hemostasis is critical during the entire procedure. The blood vessels associated with each fat compartment must be cauterized.…”

“…Postoperative retro-orbital hemorrhage is the most feared complication following lower blepharoplasty. 12 It can be accompanied with pain and decreased visual acuity with pupillary defect. Edema of the orbicularis muscle due to hemorrhage can affect visual acuity.…”