Transconjunctival Blepharoplasty

Transconjunctival blepharoplasty is a lower eyelid surgery technique designed to reduce under-eye bags by removing or repositioning excess fat through an incision made inside the eyelid. Because the approach is performed from the conjunctival side (the inner surface of the lower lid), it avoids an external skin incision—meaning there is typically no visible scar on the outside. This makes it an appealing option for patients who mainly have puffiness or fat protrusion under the eyes and do not need significant skin tightening.

The primary goal of transconjunctival blepharoplasty is to create a smoother, more rested under-eye contour while preserving the natural shape of the lower eyelid. By addressing the fullness that contributes to a “tired” or “swollen” look, the procedure can refine facial expression without dramatically changing appearance. Treatment is individualized based on anatomy, the degree of under-eye fullness, and overall skin quality, and it’s often performed as an outpatient procedure with a recovery period focused on managing temporary swelling and bruising.

What Is Transconjunctival Blepharoplasty?

Transconjunctival blepharoplasty is a lower eyelid procedure that improves under-eye “bags” by addressing the fat pads that create puffiness. The surgeon works through a small incision made on the inside of the lower eyelid (the conjunctiva), allowing access to remove, reduce, or reposition protruding fat to smooth the transition from the eyelid to the upper cheek. Because the incision is internal, there is typically no visible external scar.

This approach is best suited for people whose main concern is under-eye fullness rather than loose, crepey skin. In many cases, the goal is not to create a hollow look, but to restore a more even, rested contour by refining volume in a controlled way. When skin quality is good and eyelid support is adequate, transconjunctival blepharoplasty can deliver a natural-looking result with a scar-free exterior and a lower risk of lid retraction compared with some skin-incision techniques.

How Transconjunctival Blepharoplasty Differs From Traditional Methods

Traditional lower blepharoplasty often uses a transcutaneous (external) incision placed just below the lash line. That external approach allows the surgeon to remove or tighten skin and adjust muscle, which can be helpful when there is significant skin laxity or eyelid muscle looseness. However, it also creates an external incision (even though it’s usually well-hidden) and may carry a higher risk of changes in eyelid position if too much skin is removed or if support is not carefully managed.

Transconjunctival blepharoplasty differs by approaching the fat pads from inside the eyelid, focusing primarily on volume correction rather than skin excision. It is typically preferred for younger patients or anyone with good skin elasticity who wants improvement in puffiness without a visible scar. If mild skin texture or fine lines remain after fat adjustment, surgeons may combine the internal approach with skin-resurfacing treatments or very conservative “pinch” skin removal in selected cases rather than performing a full traditional external method.

Who Should Consider Transconjunctival Blepharoplasty?

This technique is generally considered when under-eye puffiness is the main issue and the lower eyelid skin is still relatively firm. A detailed exam is important to confirm that eyelid support and anatomy are suitable for an internal approach.

• People with prominent under-eye bags caused mainly by fat protrusion
• Patients with good skin elasticity and minimal excess lower-lid skin
• Those who want no external scar and a subtler, natural change
• Individuals with a “tired” look despite adequate sleep due to under-eye fullness
• Patients who are not primarily seeking major skin tightening
• People who are suitable candidates for fat repositioning to soften the lid–cheek junction

Benefits of Transconjunctival Blepharoplasty

The biggest advantages are the scar-free exterior and the ability to refine under-eye contour while preserving the natural lower eyelid shape. When properly selected, patients often experience a smoother, less puffy under-eye area with a refreshed appearance.

• No visible external incision or scar
• Direct access to lower eyelid fat pads for precise contouring
• Typically lower risk of eyelid “pull-down” compared with some external techniques
• Natural-looking improvement without over-tightening the lower lid
• Often faster social recovery due to less disruption of skin and muscle
• Can be combined with fat repositioning for a smoother tear trough transition

Step-by-Step Overview of the Procedure

The procedure is usually performed as an outpatient surgery and follows a structured sequence tailored to your anatomy and goals. After cleansing and numbing the area, the surgeon gently everts the lower eyelid to reach the inner surface, then creates a small incision through the conjunctiva. The fat pads are identified, and excess fat is carefully reduced or redistributed (repositioned) to smooth the under-eye contour while avoiding a hollow appearance. Once the desired contour is achieved, the incision is typically left to heal on its own or closed with dissolvable sutures depending on surgeon preference, and the eye is protected while you begin recovery instructions such as cold compresses and lubrication.

Local vs. General Anesthesia: What’s Commonly Used?

In many adults, transconjunctival blepharoplasty is commonly performed under local anesthesia, often with mild sedation for comfort. This allows the area to be numb while keeping recovery from anesthesia relatively straightforward, and it’s frequently chosen when the procedure is limited to the lower lids without extensive additional work.

General anesthesia may be used when patients prefer to be fully asleep, when anxiety is significant, or when the surgery is combined with other facial procedures that increase operative time. The best option depends on medical history, surgeon and facility protocols, and whether additional techniques—such as fat repositioning, skin tightening, or midface procedures—are planned alongside the blepharoplasty.

Recovery Time and What to Expect

Most patients experience swelling and bruising for the first several days, with the under-eye area feeling tight, tender, or mildly irritated. Temporary dryness, watering, light sensitivity, or blurry vision can occur, often related to ointments and swelling rather than the eye itself. Cold compresses, head elevation, and prescribed drops/ointment are typically recommended early on to improve comfort and reduce swelling.

Over the following 1–2 weeks, bruising usually fades and swelling steadily decreases, making the result look more natural each day. While many people return to desk work and light routines within about a week, the timing can vary depending on how quickly bruising resolves and whether your job is public-facing or physically demanding. The under-eye contour continues refining for several weeks as tissues fully settle, and follow-up visits help ensure healing is progressing smoothly and eyelid position remains stable.

Possible Risks and Side Effects

Transconjunctival blepharoplasty is generally considered a safe, well-established technique, but it can still involve temporary side effects and, less commonly, complications. Most issues are mild and improve as swelling settles and the lower eyelid tissues stabilize.

• Swelling and bruising under the eyes
• Mild pain, tightness, or soreness
• Dryness, watering, light sensitivity, or a gritty sensation
• Temporary blurred vision (often from ointment or swelling)
• Redness on the inner eyelid (conjunctival irritation)
• Under-correction (residual puffiness) or over-correction (hollowing)
• Asymmetry during early healing
• Infection or inflammation (uncommon)
• Bleeding/hematoma (uncommon)
• Corneal irritation/abrasion if dryness or eyelid closure issues occur
• Lower eyelid malposition or retraction (less common with transconjunctival, but possible)
• Temporary numbness or altered sensation around the lower lid (usually improves)
• Need for revision surgery in selected cases

How to Minimize Bruising and Swelling After Surgery

Bruising and swelling are most noticeable in the first 48–72 hours, then gradually improve. The fastest way to calm them down is to combine good early cold therapy with habits that reduce pressure and irritation in the under-eye area, while following your surgeon’s exact aftercare instructions.

For the first 2–3 days, prioritize cold compresses as directed (gentle, not heavy pressure), sleep with your head elevated, and avoid anything that increases blood flow to the face—such as heavy exercise, bending forward, hot showers/saunas, and alcohol—if your surgeon advises. Keep the eyes comfortable with prescribed lubricating drops or ointment, avoid rubbing, and protect the area outdoors with sunglasses. If you were instructed to pause blood-thinning medications or supplements, only restart them when your surgeon says it’s safe, because restarting too early can worsen bruising.

Results Timeline: When Will I See Full Effects?

You’ll usually notice an early improvement once the main swelling starts to settle, but the under-eye area can look uneven or “puffy in a different way” in the first days because fluid shifts and healing tissues temporarily change the contour. Most bruising fades within 1–2 weeks, and many patients feel socially comfortable around that time, especially if the procedure was limited to fat adjustment without additional skin work.

The “full effect” is more gradual: the lower lid and lid–cheek junction continue refining over several weeks as deeper swelling resolves and tissues soften. In many cases, results look increasingly natural between about 4–8 weeks, and subtle final settling can continue beyond that, particularly if fat repositioning was performed or if you’re prone to prolonged swelling.

Is It Safe for All Skin Types and Ages?

Transconjunctival blepharoplasty can be safe across a wide range of skin types because the incision is inside the eyelid, which reduces concerns about external scarring and pigment changes that can be more relevant with skin incisions. That said, safety and suitability still depend on anatomy and eye health: lower eyelid support, tear film/dry eye status, and the presence of conditions that affect healing all matter more than skin type alone.

Age is not an absolute limiter, but it influences candidacy. Younger patients often have good skin elasticity and are ideal when the main issue is under-eye fat bulging, while older patients may also benefit if their primary concern is puffiness but they may need additional strategies if there is significant skin laxity (for example, combining the internal approach with conservative skin treatments or other tightening methods). A surgeon’s exam is essential to confirm that the lid will remain stable and natural-looking after volume adjustment.

Transconjunctival Blepharoplasty Prices 2026

Transconjunctival blepharoplasty pricing in 2026 can vary significantly depending on the clinic’s location, the surgeon’s experience, the complexity of the case, and whether the plan includes fat repositioning or additional procedures. Fees may also differ based on anesthesia choice, facility costs, and the scope of pre- and post-operative care included in your treatment package.

For Transconjunctival Blepharoplasty prices 2026, contact us now.

Frequently Asked Questions

Does transconjunctival blepharoplasty leave scars?

Transconjunctival blepharoplasty does not typically leave a visible scar because the incision is made inside the lower eyelid. Since there is no external skin cut, the outside of the eyelid usually shows no incision line once healing is complete.

How long does swelling last after the procedure?

Swelling is usually most noticeable during the first 48–72 hours, then gradually improves. Many patients see a clear reduction within 1–2 weeks, but mild residual swelling—especially in the mornings—can linger for several weeks as the under-eye tissues fully settle.

Can fat be removed or repositioned during this surgery?

Yes. Depending on your anatomy and the surgical plan, the surgeon can either remove a controlled amount of protruding fat or reposition it to smooth the under-eye contour and soften the lid–cheek transition. The goal is to reduce puffiness while avoiding an overly hollow look.

Is the procedure painful?

Most patients report minimal pain. Discomfort is more commonly described as tightness, soreness, or irritation rather than sharp pain, and it is typically manageable with the aftercare plan your surgeon provides. Temporary dryness or a gritty feeling can also occur and is usually relieved with lubrication.

How soon can I wear makeup again?

Makeup is usually avoided until the incision area and eyelid tissues have sufficiently healed, which is often around 10–14 days, but timing can vary. Your surgeon will give the safest clearance based on how your eyelids are healing and whether any additional treatments were performed.

Are the results of transconjunctival blepharoplasty permanent?

Results are long-lasting, especially when the procedure addresses structural under-eye fat protrusion. However, the aging process continues, and changes in skin elasticity and facial volume over time can subtly affect the under-eye area. Some patients maintain their improvement for many years, while others may consider future touch-ups depending on natural aging and lifestyle factors.

What’s the difference between transconjunctival and external blepharoplasty?

Transconjunctival blepharoplasty uses an internal incision to treat under-eye fat without cutting the skin, so it typically leaves no visible scar and is best when puffiness is the main issue. External (transcutaneous) blepharoplasty uses an incision just below the lash line, allowing the surgeon to remove or tighten skin and adjust muscle, which can be better for significant skin laxity but involves an external incision and requires careful support to protect eyelid position.