[Inferior blepharoplasty: the transconjunctival approach]

Area of Science:

• Ophthalmic plastic surgery
• Cosmetic surgery
• Anatomy of the orbit

Context:

• The transconjunctival approach, first described in 1924, has seen renewed interest in recent North American publications.
• It offers an alternative to the classical transcutaneous approach for lower eyelid blepharoplasty.
• This technique involves an incision inside the lower eyelid, avoiding external scarring.

Purpose:

• To describe the technique, indications, and outcomes of the transconjunctival approach for lower blepharoplasty.
• To highlight its advantages over the traditional transcutaneous method, particularly regarding scarring and complications.
• To evaluate its suitability for different patient demographics and aesthetic concerns.

Summary:

• The transconjunctival approach involves an incision along the inferior tarsal border, allowing for either preseptal or retroseptal dissection to access orbital fat pads.
• Fat removal is conservative, focusing on protruding excess tissue, with closure via a absorbable stitch.
• Indications include young patients with prominent bags, dark-skinned individuals at risk of keloid scarring, and older patients with laxity where a 'round eye' or ectropion is a risk with classical methods.

Impact:

• The transconjunctival approach is associated with extremely rare complications, making it a preferred method for many contemporary surgeons.
• It provides a solution for residual fat after previous surgeries and minimizes the risk of ectropion or 'round eye' deformity.
• This technique is becoming the standard approach for lower blepharoplasty due to its safety profile and aesthetic outcomes.