Transconjunctival blepharoplasty. Complications and their avoidance: a retrospective analysis and review of the literature.

The transconjunctival approach to lower eyelid blepharoplasty is becoming increasingly popular. From 200 transconjunctival blepharoplasties performed between 1984 and 1991, 40 randomly selected cases were reviewed to identify the complications associated with this technique. This represents the largest reported series (to our knowledge) in the English-language otolaryngology head and neck surgery literature. A review of the literature was performed to compare this series with reported complications associated with this approach, as well as to compare the reported complications from the transcutaneous method. Discussion on how to best avoid these complications is included. We found that the transconjunctival approach avoided the most common complication associated with transcutaneous blepharoplasty, lower lid malposition. Inadequate fat removal, the most common complication when the transconjunctival method was used, was believed to be best avoided by the careful graded and through removal of herniated lower lid fat. Patients exhibiting prominent fat without excess lower lid skin were found to be ideal candidates for transconjunctival blepharoplasty.