Why is transcutaneous lower blepharoplasty a dangerous technique?
Before / after
Real cases from the practice, unretouched, framed on the treated area only. Each result is individual and does not predict yours.
Photographs published with the patients’ written consent.
Written and reviewed by Dr Bernard Hayot, ophthalmologist, RPPS 10003926226.
What is transcutaneous lower blepharoplasty?
Transcutaneous lower blepharoplasty is a specific surgical procedure designed to improve the appearance or the function of the lower eyelids. It involves an external incision made just below the lash line, giving access to the underlying tissues. With this method, the surgeon can precisely remove excess skin, fat pads or sagging tissue, while treating the deep wrinkles that mark this delicate area of the face.
This technique is particularly useful for patients with under-eye bags, excess sagging skin or lax tissue. It can also correct signs of fatigue or ageing that alter the overall appearance of the eyes, giving a more youthful, rested look.
However, despite its apparent advantages, transcutaneous lower blepharoplasty is known for the risks it can entail, not least because of the sensitivity and complexity of this anatomical area.
The tissues of the lower eyelids are particularly thin and delicate, which increases the likelihood of complications such as visible scarring, skin irregularities or side effects such as eyelid retraction.
In addition, direct manipulation of the fat pads requires great precision. Removing too much fat, or redistributing the tissue poorly, can alter the natural balance of the face and create a hollow or tired appearance. For these reasons, this technique is often described as risky, especially when it is not performed by a surgeon experienced in cosmetic eyelid surgery.
Despite these drawbacks, some patients find this approach effective, especially when it is well suited to their particular anatomy and needs. Before choosing this method, however, it is essential to understand fully its implications, its possible results and the available alternatives, such as transconjunctival blepharoplasty, which offers significant advantages in terms of safety and aesthetics.
Risks associated with transcutaneous blepharoplasty
Transcutaneous lower blepharoplasty is a popular surgical procedure for improving the appearance of the lower eyelids, but it carries risks that it is important to be aware of. This method, which involves an external incision below the lash line, can lead to a variety of aesthetic and functional complications.
Visible scars and skin irregularities on the eyelids after transcutaneous lower blepharoplasty
The transcutaneous route requires an external incision, which exposes patients to the risk of visible scarring. Although surgeons try to make the incision discreet, some scars may become hypertrophic, irregular or poorly positioned, affecting the appearance of the eyes. These skin imperfections may require corrective treatments such as injections or laser sessions. If healing is poor, the overall appearance of the eyelids can be compromised, affecting the symmetry and harmony of the face.
Risk of eyelid retraction after transcutaneous lower blepharoplasty
One of the major risks of this operation is retraction of the lower eyelid, also known as ectropion. This complication occurs when the eyelid is pulled downwards, exposing the eye excessively and leading to eye problems such as dryness, irritation or even impaired vision. Such a situation may require further surgery to restore the natural position of the eyelid and avoid lasting damage.
Fat and tissue complications after transcutaneous lower blepharoplasty
Direct manipulation of the fat pads under the eyes is a key step in transcutaneous blepharoplasty, but it involves certain dangers. Removing too much fat can create a hollow effect, making the face look tired and compromising the natural balance of the eyes.
Conversely, inadequate redistribution of fat or tissue can lead to asymmetry or aesthetic irregularities. In addition, the formation of internal scar tissue can restrict the natural mobility of the eyelids and cause lasting discomfort.
Risks of infection and bleeding after transcutaneous lower blepharoplasty
Like all surgical procedures, lower blepharoplasty carries a risk of infection or bleeding. Poorly controlled infection can damage the surrounding tissues and prolong recovery.
Excessive bleeding, although rare, may require emergency surgery. These complications, together with the possible effects of anaesthesia, underline the importance of choosing a qualified, experienced surgeon.
Postoperative asymmetry after transcutaneous lower blepharoplasty
Even with an excellent surgeon, the risk of asymmetry after blepharoplasty is not negligible. It may be due to differences in healing, poor tissue handling or an unpredictable response from the patient’s body. Visible asymmetry or an unbalanced look may require surgical touch-ups, lengthening recovery and increasing the overall cost of the procedure.
A safer alternative with transconjunctival blepharoplasty
Given the risks associated with the transcutaneous approach, many surgeons now prefer the transconjunctival technique. It involves making an incision inside the eyelid, thereby avoiding any visible external scar.
The advantages of the transconjunctival route:
No external scarring
The incision is made inside the eyelid, preserving the natural appearance of the eyelids and avoiding any visible scar on the skin.
Reduced risk of eyelid retraction
This method minimises stress on the tissues and considerably reduces the risk of ectropion and other functional complications.
Better fat conservation
Rather than removing the fat pads completely, this technique redistributes them harmoniously, giving a more balanced result and a more youthful look.
Faster recovery
Because there is no external incision, recovery is often shorter, with less swelling, scarring and post-operative complications.
In addition, some patients may benefit from a temporal lift or other non-invasive aesthetic procedures to optimise results without external incisions.
However, the transconjunctival route is not suitable for every patient, particularly those with marked excess skin. A prior consultation with a qualified surgeon is essential to determine the most appropriate method in each case.
Choosing the right technique
Transconjunctival blepharoplasty is particularly suitable for patients with fat pads but no significant excess skin. Conversely, for patients with marked skin laxity or drooping eyelids, transcutaneous blepharoplasty can sometimes be more effective. A consultation with a qualified surgeon is essential to assess each patient’s case and determine the most appropriate method.
In conclusion, although transcutaneous blepharoplasty can give excellent aesthetic results, its risks must be weighed carefully. Transconjunctival blepharoplasty, by contrast, offers a less invasive alternative, with results that are often more natural and a shorter recovery period.
How to minimise risk?
Lower blepharoplasty, while effective for rejuvenating the eyes and correcting functional or aesthetic problems of the lower eyelids, can involve certain risks if it is not performed under optimal conditions. To reduce these surgical risks and ensure a satisfactory result, it is essential to take preventive measures before, during and after the operation.
Choose a qualified, experienced surgeon
A surgeon specialising in cosmetic eyelid surgery is essential to minimise complications. Check the qualifications, the experience and the patient reviews before choosing your practitioner. A good surgeon will be able to analyse your eyelid anatomy and skin type, and adapt the technique to your specific needs, whether a transconjunctival approach or a more conventional method.
If in doubt, ask to see before-and-after photographs of similar procedures, which will give you a better idea of the possible results.
Opt for a personalised assessment
Each patient has particular needs depending on facial structure, skin condition and the presence of fat pads or wrinkles. A thorough consultation is essential to determine whether surgery is necessary or whether other non-invasive aesthetic treatments might suffice. During this assessment, the surgeon will take into account factors such as:
- Excess skin or fat on the lower eyelids.
- Skin quality and elasticity.
- Any history of eye problems or previous surgery.
Follow pre- and post-operative instructions
- Before surgery: avoid medicines that may increase the risk of bleeding, such as aspirin or anti-inflammatory drugs. Prepare your skin with the care prescribed by your surgeon.
- After the operation: use cold compresses to reduce inflammation, apply the creams or ointments that promote healing, and observe strict hygiene to prevent infection.
Recovery varies from patient to patient, but most can resume their daily activities after two to three weeks, while avoiding strenuous physical exertion.
Consider complementary non-surgical treatments
In some cases, non-invasive aesthetic treatments can be an alternative or a complement to blepharoplasty. Techniques such as hyaluronic acid injections, laser or radiofrequency can reduce the appearance of wrinkles and improve the quality of the skin around the eyelids.
These options are ideal for patients with moderate signs of ageing, or who wish to avoid the scars associated with surgery.
Avoid rushing into surgery
It is important to think carefully before undergoing eyelid surgery. Take the time to consider the different techniques, such as the transconjunctival technique, which leaves no external scar, or the conventional technique for treating more marked excess skin.
Discuss the advantages, the drawbacks and the expected results with your surgeon in order to choose the method best suited to you.
Protect your eyes during recovery
After blepharoplasty, it is essential to protect your eyes to avoid eye complications. Wear sunglasses to shield the area from external aggressions such as UV rays, wind or dust. If eye irritation occurs, contact your surgeon promptly for appropriate follow-up.
Transconjunctival blepharoplasty procedure
Transconjunctival blepharoplasty is a modern, discreet cosmetic surgery technique, ideal for correcting fat pads on the lower eyelids without leaving visible scars. The surgeon makes a small incision inside the eyelid, at the level of the conjunctiva, to reach the excess fat.
This method makes it possible to remove or reposition the fatty tissue while preserving the integrity of the skin. The absence of external incisions not only reduces the risk of infection and skin complications, but also ensures a natural, harmonious aesthetic result.
Transconjunctival blepharoplasty is particularly indicated for patients who still have firm skin and few eyelid wrinkles. After the operation, the eyes look fresher and younger, without altering the overall appearance of the face.
To conclude
While transcutaneous lower blepharoplasty may seem an attractive way of correcting certain aesthetic problems, its risks should not be underestimated. Complications such as visible scarring, eyelid retraction or skin irregularities underline the importance of choosing the right technique and the right surgeon.
The transconjunctival technique, although it also has its limitations, is a safer alternative for many patients. Whatever the choice, careful assessment and rigorous preparation are the keys to a satisfactory result with minimal risk.
By choosing a competent surgeon and following post-operative instructions scrupulously, you maximise your chances of success and satisfaction.
This page is for information. It does not replace a consultation: every situation is judged on examination.