I see patients every day in my office who are concerned with bags and wrinkles on their lower eyelids. The different surgical approaches to the lower lids can be confusing to patients, so here are some commonly asked questions.
Q: What is the difference between the “trans-conjuctival” approach and the “sub-cillary” approach in lower eyelid cosmetic surgery?
A: In the transconjunctival approach, the incision is made on the inside of the eyelid, so that there is no scar and no stitches. This is an excellent choice for younger patients who only have eyelid bags without excess skin and sagging muscle. The advantage of this approach is that the incision is made on the inside of the eyelid, so the recovery is much faster. The disadvantage is that sagging skin cannot be corrected with this approach. I will often combine a transconjunctival blepharoplasty with a laser resurfacing to the lower eyelids. The laser helps to improve the quality of the skin and reduces fine lines and wrinkles.
In the subciliary approach an incision is made just below the eyelashes. This allows a more aggressive solution for patients who have sagging skin, excess rolls of muscle, or skin and muscle that are hanging.