Transconjunctival Lower Lid Blepharoplasty with and Without Fat Repositioning

The title of this chapter is descriptive in that it reviews a posterior eyelid (conjunctival) approach to cosmetic rejuvenation of the lower eyelid. The designation of the procedure as transconjunctival is important in that it differentiates surgery from the more traditional transcutaneous (through the skin) approach. Transconjunctival blepharoplasty has become the most common approach to cosmetic lower lid surgery over the last decade.1 Since I have been in practice, I have only rarely performed transcutaneous lower blepharoplasty, and not at all in the last 7 years. This is because, in my critical evaluation of this surgery and in my hands, the posterior eyelid approach yields excellent results, with high patient satisfaction and fewer complications.