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Transconjunctival Blepharoplasty

Eyelid surgery, or blepharoplasty, consistently ranks as one of the most popular facial cosmetic surgery procedure in the United States. Transconjunctival blepharoplasty is a type of lower eyelid surgery, which is performed without any external incisions. When expertly performed, the eyes look completely natural without any visible sign of surgery such as scars or the “over-pulled” look.

Before and After lower eyelid surgery using Transconjunctival Blepharoplasty technique - female patient
Before and After lower eyelid surgery using Transconjunctival Blepharoplasty technique - female patient

What is Transconjunctival Blepharoplasty?

A lower Blepharoplasty can be done from either an external (transcutaneous or “through the skin”) approach or an internal (transconjunctival or “through the conjunctiva”) approach. Dr. Amiya Prasad is an expert at performing both types of lower eyelid blepharoplasty

The eyelids are composed of delicate layers of tissue including skin and muscle. The eyelids are intimately related to the eye and the bone structure around the eye called the “orbit”. Fat pockets which are part of the orbit can prolapse or herniate forward resulting in under eye bags.

Transconjunctival blepharoplasty is method of improving the appearances of eye bags which have herniated forward, from behind the eyelid without any external scar.

surgery to remove bags under eyes before and after
under eye bag surgery before and after

Eye Bags Causes

The eyes convey emotion and non-verbal communication. Weary looking eyes can often convey the wrong feeling or message. The problem of puffy or enlarged under eye bags is frequently a genetic issue. This means that younger patients, even as early as in their teens, can be candidates for lower eyelid blepharoplasty.

The cause of puffy eye bags is the naturally occurring fat pockets around the eyes pushing forwarded and creating a bulge (AKA lower eyelid fat prolapse, or herniated fat). Frustrated with buying creams that don’t work, many people contact us to know how to get rid of puffy eyes.

Very often, remarks about looking tired, weary, and lacking energy are based primarily on the appearance of the eyes. Comments about “looking tired” even when well-rested is one of the most common reasons for inquiring about eyelid procedures.

Candidates for Transconjunctival Blepharoplasty

Lower eyelid surgery or lower eyelid blepharoplasty performed through a transconjunctival approach is very popular at Prasad Cosmetic Surgery. The cost of this surgery is less than many facial procedures and can have a dramatic impact on your appearance. You may be a candidate for Transconjunctival Blepharoplasty if:

  • you have lower eye bags
  • look tired
  • good lower eyelid muscle and skin tone
before and after transconjunctival blepharoplasty on male patient
before and after transconjunctival blepharoplasty on male patient

Benefits Of Transconjunctival Blepharoplasty

The goal of a blepharoplasty is to maximally rejuvenate the eyes with long-lasting results. Although many surgeons write about specific techniques, each patient is different and the eyelid rejuvenation plan has to be customized for you. The Transconjunctival incision offers various benefits compared to traditional lower eyelid surgery:

  1. No outside scars
  2. The eye shape is better preserved
  3. Faster recovery
  4. Less trauma around the eyes
  5. Reduced bruising and swelling

What are the risks of lower eyelid surgery cosmetic lower eyelid surgery?

lower eyelid blepharoplasty is amongst the most popular cosmetic surgical

procedures performed throughout the world the appearance of puffy eye bags

that are present all the time is due to bulging fat and is commonly genetic in

origin as well as being associated with facial aging the genetic aspect of this

condition is why many younger people have under-eye bags the most effective

and longest lasting procedure for puffy eye bags is lower eyelid surgery to

sculpt the fat responsible for the under eye bags

the popularity of lower eyelid surgery can make it appear to be a generic

procedure in actuality it’s anything but generic many surgeons performing this

category of surgery use a one method fits all approach resulting in many

people needing corrective procedures by specialists like myself the lower eyelid

is a complex structure and the art is in creating the optimal strategy to get the

most satisfactory result with minimal risk for complications I’ll discuss how

I assess my patients and how I customized the procedure to minimize the

risks related to lower eyelid surgery I’m Dr. Amiya Prasad I’m a

Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic

and reconstructive surgeon I’ve been in practice in Manhattan and Long Island

for over 20 years as an oculoplastic surgeon who specializes in cosmetic

eyelid surgery I routinely perform lower eyelid blepharoplasty as well as eyelid

revision surgery for complications after surgery originally performed by other

doctors I’ve observed throughout my career that a lot of complications after lower eyelid surgery occur because the surgeons performing

this procedure are not fully aware of the ways to avoid compromising the

support structures intrinsic to the lower eyelid anatomy one of the more

common risks of lower eyelid blepharoplasty is lower eyelid

retraction the degree of eyelid retraction can be such that the eyes

look rounded after surgery and the patient loses the characteristic shape

of their eyes I’ve seen patients who had this problem after surgery and their

original surgeon denied that the patient had a rounded appearance of their lower

eyelids it seems that there’s been a normalization of rounded lower eyelids

similar to the normalization of high arched eyebrows and overfilled lips this

is why during consultations patients will often express their disdain for the

look of some famous people who they feel look like they’re a deer in headlights

so what is the cause for this eyelid retraction problem well the most

commonly performed surgical technique to address fat under the eyes which causes

puffy eye bags is called transcutaneous blepharoplasty this technique involves

making an incision in the lower eyelid right below the eyelashes to access the

fat pockets responsible for puffiness the transcutaneous blepharoplasty

technique is often performed by general plastic surgeons this approach has the

potential to compromise the strength of the eyelid structure by separating the

layers which are stronger when intact in addition there is potential compromising

of the function of the orbicularis oculi muscle which works like a belt

supporting the lower eyelid this can lead to the lower eyelids sagging or

pulling downward making the eyes look rounded instead of

retaining their original shape and it’s referred to as lower eyelid retraction

the lower eyelids may also rotate inward causing irritation from the eyelashes

known as entropion or avert outward causing irritation from exposure known

as ectropion further worsening this compromise of the integrity of the lower

eyelids is caused by the common practice of eyelid skin removal as a strategy to

improve the appearance of fine lines and wrinkles

a common misconception held by many surgeons and the general public is that

the fine lines and wrinkles are the result of excess lower eyelid skin so

many surgeons excise skin when performing transcutaneous bluffing this

removal of skin often leads to the lower eyelids retracting even further and can

lead to a more rounded look and worse a skin shortage where the eye is not

adequately protected this can cause the tears to not be evenly distributed over

the eyes to maintain proper eye health in some situations there can even be a

limitation in high closure when sleeping I approach lower eyelid retraction

ectropion and aunt ro beam with one guiding principle restoration of anatomy

eyelids that look good function well this means for eyelid retraction in

order to restore anatomy I have to use tissue grafts such as dermis cellular

matrix graft and even skin grafts to reconstruct and provide vertical support

I also have to repair the anatomic structural connection to the bone called

the lateral canthal tendon each patient situation is unique and requires proper

evaluation I use advanced wound healing technology such as PRP or platelet-rich

plasma and a cellular matrix to improve my patient

tissue healing and consequently their outcomes it’s often the case that lower

eyelid fat prolapse is associated with the deficiency in the projection of the

cheek bone and bone structure under the eyes the paradox is that there is excess

fat pushing forward while deficient bone is not projecting forward enough I

usually recommend placement of hyaluronic acid filler at the bone level

to address bone volume deficiency some doctors advise fat repositioning with

lower eyelid surgery where a small extension of fat still connected to the

eye is stretched and bent over the bone to try to address this deficiency this

pedicle of fat is usually too small to address hollowing and the blood supply

is kinked over the bony orbital rim resulting in prolonged swelling

irregularities or the fat just dying from the blood vessels being bent and

compressed to provide adequate volume as well as a more predictable result I use

hyaluronic acid fillers such as Restylane and Juvederm to address

hollowness in the lower eye area as well as the cheek bones I bring to my

patients attention the relationship between the bone structure around the

eyes and the eyes themselves so they can look their best it is of course much

better to completely avoid lower eyelid retraction of other complications than

it is to need extensive and expensive revision surgery so many people opt for

cheaper lower eyelid surgery to save money without understanding why the

surgery is being done so cheaply quality and cheap simply don’t go together so

opting for cheaper lower eyelid surgery can be much more expensive to fix not to

mention the cost of time off work and the expenses of travel

so how do I minimize the risk of lower eyelid retraction I start with the

approach of preserving the lower eyelid support structures such as the lower

eyelid skin and the orbicularis oculi muscle I preserve lower eyelid Anatomy

by using a specialized technique called transconjunctival blepharoplasty

transconjunctival blepharoplasty involves no external incision because

the fat pockets responsible for under eye bags are sculpted from behind the

eyelid the lower eyelid skin and the orbicularis oculi muscle are completely

preserved and the results look natural since there is no scar from an external

incision and there is no compromise in the support structure I also avoid skin

removal because under eye wrinkles and fine lines are an issue of skin quality

not excess skin quantity for under eye wrinkles I improve the quality of the

skin by stimulating collagen production and resurfacing the skin collagen can be

stimulated using a laser or radiofrequency device to induce collagen

production collagen is the protein that gives skin its strength in addition the

application of heat also makes the skin contract and tighten to further

stimulate collagen production and blood supply in the lower eyelid skin without

heat I use platelet-rich plasma platelet-rich plasma also called PRP is

a concentration of wound healing and growth factors present in the blood

which are activated when you have a cut if there is redundant lower eyelid skin

or a fold I’ll perform a skin pinch excision I still focus on maintaining

the natural shape and the character of the lower eyelids I perform lower eyelid

surgery under local anesthesia with Lite IV sedation

so patients don’t have to deal with the stress of general anesthesia as well as

the side effects of general anesthesia patients are comfortable throughout the

surgery and what is generally referred to as a twilight state of consciousness

they walk out of our office alert and happy soon after surgery most of our

patients have little to no bruising and return to work in about a week like any

surgery there are always risks, risks can be minimized through the experience

expertise and techniques used by the surgeon coming from an ophthalmology

background and having an understanding of how to maintain the shape and retain

the healthy function of the eyelids has been invaluable for my ability to help

my patients undergoing lower eyelid surgery I hope you found this

information helpful thank you for your question

How is the procedure done?

It’s important to understand that lower eyelid surgery is complex, and a great deal of finesse is required in order to maintain the right support to the area and not change the shape of the eye.

During the procedure, the lower eyelid is approached from the inside and the fat pockets are sculpted and repositioned. One of the advantages of this approach is that the eyelid is not approached from the skin side or from the front which makes it more precise to gauge the effect of fat sculpting as the operation progresses.

Dr. Prasad evaluates the results throughout the procedure to make sure that the shape and contour of the eyes are created as desired. If needed, Dr. Prasad may also tighten any loose skin after the fat is removed. This process usually involves the use of lasers such as the fractional CO2 laser. This method typically results in quicker recovery when compared to the transcutaneous (external approach) blepharoplasty.

Dr. Prasad performs transconjunctival blepharoplasty under local anesthesia with LITE IV sedation (twilight anesthesia) so there is no need for general anesthesia.

To improve the eyelid skin quality and dark circles in some patients, Dr Prasad will often use PRP ( platelet-rich plasma) which is derived from the patient’s blood. The platelets which are important cells for healing and many growth factors are separated from the plasma by centrifugation. The PRP is then placed under the skin to improve the skin quality and the appearance of dark circles.

Lower Eye bags Before and After surgery - male patient
Lower Eye bags Before and After surgery - male patient

Quick recovery

Dr. Prasad is a pioneer in performing eyelid surgery such as transconjunctival blepharoplasty with local anesthesia with IV sedation. Using local anesthesia with IV sedation means that patients do not have to be put under general anesthesia.

Advantages of this technique is that patients:

  • recover from surgery faster,
  • have faster surgery time
  • have less bruising
  • avoid the complications associated with
  • general anesthesia (being unconscious and breathing through a respirator).

Dr. Prasad trademarked his Quick Recovery technique using LITE™ IV sedation – a combination of local anesthesia with IV sedation to make his patients comfortable during their procedure.

Before and after Lower Eyelid retraction surgery - female patient
Before and after Lower Eyelid retraction surgery - female patient

“Enhance the Look of Your Eyes with Transconjunctival Laser”

Personalized Eye surgery

Transconjunctival blepharoplasty is a type of eyelift surgery that is performed for people of all ethnic backgrounds. It is performed to improve the appearance of bags and loose skin under the eyes. Puffy eyes are frequently caused by bulging fat pockets in the lower eyelids.

Dr. Prasad performs transconjunctival laser blepharoplasty to sculpt this fat. This procedure is performed internally, producing no outside scars and preserving the natural shape of the eye.

This 53-year-old woman from South America was accustomed to always looking young but was noticing how she was looking older because of the appearance of her eyes.

Frustrated with applying makeup to hide the bags under her eyes, she came to Dr. Prasad and underwent lower eyelid transconjunctival blepharoplasty. She appreciated Dr. Prasad’s familiarity with the concerns people of all skin types in terms of scars and keloids. Dr. Prasad specializes in eyelid surgery for all ethnic skin types and was one of the first Oculoplastic Surgeons to teach about the unique needs of people of different ethnic backgrounds.

lower eyelid plastic surgery before after
lower eyelid plastic surgery before after

Blepharoplasty for Older Patients

While most surgeons believe transconjunctival blepharoplasty is only appropriate for younger patients with no excess eyelid skin, this procedure can can work well for older patients. Many older patients with large eye bags are concerned that once the fat is addressed, the skin would droop and sag.

As Dr. Prasad explains, “the eyelid is supported by the orbicularis oculi muscle which acts like a belt, and can tighten the lower eyelid skin once fat has been removed. This muscle can be active in older patients – even when a considerable amount of fat has been removed, the orbicularis muscle can tighten the loose skin”.

Before and After Eye bags surgery on older female patient
Before and After Eye bags surgery on older female patient

Does non-surgical option for eyebags works?

Unfortunately creams cannot treat eyebags caused by herniated fat. Since these enlarged fat pockets are underneath the skin, topical creams, ointments and other non surgical treatments are ineffective.

While the use of non-surgical fillers can temporarily treat select cases of puffy eyes by camouflaging the bulges of fat, the best candidates for this type of procedure have minimal fat prolapse. These fillers are temporary and in many situations, the bruising from fillers may last longer than the minimal bruising seen in Dr. Prasad’s surgery. Very often, fillers are used by non surgical doctors in a way which cause eye bags to appear even larger. Dr. Prasad is often consulted to dissolve or remove these fillers when events like this occur.

Transconjunctival Blepharoplasty Cost

The cost of transconjunctival blepharoplasty is based on (1) surgeon’s fee, (2) anesthesia fee, (3) facility fees, and (4) extensiveness of the surgery. Dr. Amiya Prasad performs his surgeries at a state-of-the-art surgical facility to provide the highest level of safety for his patients. Financing options are also available.

New York Cosmetic Surgeon Doctor Amiya Prasad in his office

Super-Specialist and Artistry for the Eye Area

Choosing an Oculofacial Plastic Surgeon

Dr. Amiya Prasad has the rare specialty among cosmetic surgeons titled as an Oculoplastic / Oculofacial Plastic Surgeon. This super-specialty of being an Oculofacial Plastic Surgeon (ophthalmic plastic and reconstructive surgeon) involves being trained as a facial cosmetic surgeon as well as an ophthalmologist. Further, Dr. Prasad performs full body cosmetic surgery and is a Diplomate of the American Board of Cosmetic Surgery.

He routinely performs facial cosmetic procedures such as facelift, necklift, browlift, cheek implant and chin implant. This expertise, along with Dr. Prasad’s unique artistic and natural aesthetic style, has made him a highly sought after eyelid specialist in New York and around the world.

Being a leading Oculofacial Plastic Surgeon has also brought many patients who had eyelid surgery performed elsewhere to Dr. Prasad for revision and correction. Patients who have had too much eyelid skin removed by other doctors, resulting in drooping eyes, or worse having eyelids with impaired function, come from all over the world to have their eyelids reconstructed by Dr. Prasad.

Patient Reviews Transconjunctival Blepharoplasty

I do need to comment on the whole staff because from the start to completion of my lower eyelid surgery, they worked wonderfully together as a team. I’m enjoying looking in the mirror even more! Reviewer: HwardO
I put my trust in a terrific doctor and it turned out terrific. I highly recommend Dr. Prasad for any procedure for your eyes. Reviewer: Asophalose
Dr. Prasad is an amazing Doctor! He has significantly impacted my life performing lower blepharoplasty. I am happier than I can ever recall. Reviewer: Rose

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