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Extended Transconjunctival Lower Eyelid Blepharoplasty with Release of the Tear Trough Ligament and Fat Redistribution

Wong, Chin-Ho M.R.C.S. (Ed.), F.A.M.S.(Plast. Surg.); Mendelson, Bryan F.R.C.S.(Ed.), F.R.A.C.S.

Plastic and Reconstructive Surgery: August 2017 - Volume 140 - Issue 2 - p 273-282
doi: 10.1097/PRS.0000000000003561
Cosmetic: Original Articles
Journal Club
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Background: The transconjunctival lower eyelid blepharoplasty is advantageous for its quick recovery and low complication rates. Conventional techniques rely on fat removal to contour the lower eyelid. This article describes the authors’ extended transconjunctival lower eyelid blepharoplasty technique that takes dissection beyond the orbital rim to address aging changes on the midcheek.

Methods: From December of 2012 to December of 2015, 54 patients underwent this procedure. Through a transconjunctival incision, the preseptal space was entered and excess orbital fat pads were excised. Medially, the origins of the palpebral part of the orbicularis oculi, the tear trough ligament, and orbital part of the orbicularis oculi were sequentially released, connecting the dissection with the premaxillary space. More laterally, the orbicularis retaining ligament was released, connecting the dissection with the prezygomatic space. Excised orbital fat was then grafted under the released tear trough ligament to correct the tear trough deformity. When the patients had significant maxillary retrusion, structural fat grafting was performed at the same time.

Results: The mean follow-up was 10 months. High satisfaction was noted among the patients treated with this technique. The revision rate was 2 percent. Complication rates were low. No chemosis, prolonged swelling, lower eyelid retraction, or ectropion was seen in any patients.

Conclusion: The extended transconjunctival lower blepharoplasty using the midcheek soft-tissue spaces is a safe and effective approach for treating patients presenting with eye bags and tear trough deformity.


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Singapore; and Toorak, Victoria, Australia

From the W Aesthetic Plastic Surgery; and The Centre for Facial Plastic Surgery.

Received for publication September 29, 2016; accepted January 26, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No external funding was received.

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Chin-Ho Wong, M.R.C.S. (Ed.), F.A.M.S.(Plast. Surg.), W Aesthetic Plastic Surgery, Suite 06-28/29, Mount Elizabeth Novena Specialist Center, 38 Irrawaddy Road, 329563, Singapore,

Copyright © 2017 by the American Society of Plastic Surgeons