What each approach can do
Transconjunctival — internal incision through the conjunctiva. Can:
- Remove or reposition lower-lid fat pads
- Address tear-trough hollow (when combined with repositioning)
- Leave no external scar
Cannot:
- Directly remove external skin
- Tighten the orbicularis muscle
- Address festoons or significant skin laxity
Subciliary — external incision 2 mm below lash line. Can:
- Remove external skin directly
- Address all three structures: skin, muscle, fat
- Combine with canthopexy for lid support
Trade-off:
- Visible (though typically excellent) scar
- Slightly higher risk of lower lid retraction in inexperienced hands
How the choice is made
Three findings on examination determine the right choice:
- Skin laxity — minimal: transconjunctival; significant: subciliary
- Lid vector — negative vector: transconjunctival preferred, or subciliary + canthopexy
- Patient age — broadly: <50 transconjunctival; >55 subciliary; 50–55 either
A hybrid exists: transconjunctival + skin pinch — internal fat correction plus a small ellipse of skin removed directly. Useful when skin laxity is mild.
Why this matters so much
The most common cause of unsatisfying lower-lid results is technique mismatched to anatomy:
- Transconjunctival on a patient with significant skin excess → bags are gone but lower lid looks crepey and old
- Subciliary on a young patient with elastic skin and no skin excess → unnecessary external scar, increased retraction risk, longer recovery
The surgeon's job is to identify which is right for your case — not to default to one technique for every patient.
Frequently asked questions
Why don't all surgeons do both techniques?
Some do; some specialise. Surgeons trained primarily in one technique sometimes recommend that technique to all patients — a red flag. A good consultation discusses both options and explains why one is chosen.
Ready to discuss your case?
Doç. Dr. Erdal personally reviews every enquiry. Honest assessment of whether blepharoplasty is right for you, with no pressure to book.