Related Experiment Video
Updated: Jun 25, 2026
07:30
Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
11.5K
Transconjunctival or Transcutaneous Approach for Fat-preserving Lower Lid Blepharoplasty?
Bishara Atiyeh1, Edwin Chrabieh1, Kareem Makkawi1
1From the Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Plastic and Reconstructive Surgery. Global Open
|December 19, 2025
Summary
Lower lid blepharoplasty (LLB) can be safely performed using transcutaneous or transconjunctival incisions. While fat repositioning is possible with both, fat grafting may offer better results for tear trough deformities, though more research is needed.
Area of Science:
- Oculoplastics
- Facial Plastic Surgery
- Ophthalmic Plastic Surgery
Background:
- Lower lid blepharoplasty (LLB) techniques have evolved, moving away from traditional subciliary incisions.
- Orbital fat preservation and repositioning are increasingly favored over simple excision.
- Current debate centers on the optimal incision for fat repositioning: subciliary transcutaneous vs. transconjunctival.
Purpose of the Study:
- To determine the most effective approach for pedicled orbital fat repositioning in lower lid blepharoplasty.
- To compare subciliary transcutaneous and transconjunctival incisions for LLB fat repositioning.
Main Methods:
- Systematic review of cohort clinical studies (2000-2025).
- Searched PubMed, Embase, and Web of Science databases.
- Adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Main Results:
- Twenty-four studies were included in the analysis.
- Both transcutaneous and transconjunctival approaches allow safe LLB with fat excision or flap transposition.
- Pedicle fat flap transposition and fat grafting appear to achieve similar outcomes.
Conclusions:
- LLB is safe with both transcutaneous and transconjunctival incisions.
- Orbital fat transposition is feasible with both, though potentially easier via transcutaneous approach.
- Fat grafting may be superior for lid-cheek junction blending and tear trough correction; however, LLB literature requires more rigorous outcome and complication reporting.
