Kosmetische Medizin 2-2010: 74 – 79

Blepharoplasty of the lower Eyelid:
Transconjuctival vs. Transcutaneous approach


KEY WORDS: Transconjunctival blepharoplasty of the lower eyelid, transcutaneous blepharoplasty of the lower eyelid, incision methods, fat-resection, fat-release

In the last years aesthetic surgery of the eyelid became more important. As the health insurance companies are accepting the costs for surgery of the upper lids, the patient himself has to cover the costs for the lower eyelid. The variety of therapeutical possibilities – based on modern technologies – require a systematic analysis of the pathological changes. Then a plan for the approach based on the individual of the patient can be made and if necessary multistage. Based on the respective pathological alteration the treatment concept involves the injection of filler oder botulinum toxin, the use of technical equipment (several lasers) as well as the choice in case of lower lid blepharoplasty.

The transcutaneous blepharoplasty starts with a subciliary incision, the opening of the orbital septum, a fat-resection or a fat-release and in some cases a tarsal strip-procedure or an orbicularis flap, in the end of course a dermal suture is performed. The transconjunctival blepharoplasty is mostly performed by a CO2-Laser (cw-mode). The incision is made approximately 7-8 mm behind the lid margin, followed by the opening of the capsulopalpebral fascia with the eyelid retractors, the exposure of Lockwood ligament as well as the exposure of all three fat compartments. They can be resected or modulated. There is no visible suture. The choice of the approach and the decision about are based on the pathological factors, that have to be corrected.