Transconjunctival Approach to Lower Eyelids
Video transcript: There are two main approaches to the lower lid; an internal or transconjuctival approach, or external also called the subcilliary approach.
In the transconjuctival approach, a small incision is placed on the inside of the eyelid. This allows for access to the orbital fat. In patients who only have bulging orbital fat, this is a great technique for removing that fat without having to make an incision externally.
Here’s two patients both with lower lid puffiness. This approach is indicated generally in patients under the age of 40 who often don’t have excess or lax skin; so by simply removing the fat, it improves the contour of the lower lid.
The procedure requires a small incision in the conjunctiva, so just inside the lower lid a small incision is made. The lid retractor muscles are then incised and separated. This allows access to the orbital fat. This orbital fat is then removed and meticulously cauterized because it does have small blood vessels that supply the fat that’s removed, so once these are cauterized the fat is removed and the lid is closed.
Most cases the lid incision heals without the need for any sutures. This is a before and after photo of a patient in her 20’s. She has bulging of the lower eyelids because the fat that is bulging forward through the lid structure. Rather than excising skin or making a skin excision, I simply went through the inside of her lid and removed the fat and closed it, and in most cases that gives a nice result.
This is also a patient that also had a similar problem with bulging of the lower lid fat that was simply removed through the transconjuctival approach.