Although the subcilliary or conventional transconjunctival approach has been widely used, it often fails to get acceptable visual fields or scars. This study directly compared the extended transconjunctival approach accompanied by lateral paracanthal incision with other traditional approaches in terms of surgical fields, the outcomes and complications. This retrospective chart review included 113 patients (82 males and 31 females; mean age: 38.7 years; range: 11–87 years), who underwent orbital reduction from November 2009 to September 2013. In extended transconjunctival approach, the external skin of the inferolateral canthal tendon was demarcated in a natural skin crease approximately 5 mm from the lateral canthus. The surgical approach was based on anteroseptal transconjunctival dissection. Paracanthal incision about 5 mm in length was performed. Esthetic and functional complications were evaluated, including the presence of a visible scar, lid retraction, or hypertrophic scar; epiphora, diplopia, global hematoma, persistent enophthamos, or exophthamos; and presence of entropion/ectropion. The extended transconjunctival approach resulted in a significant increase in the area of the surgical field statistically significant (P = 0.002). Complication rates are similar with other approach techniques. Postoperative scarring was confirmed by pictures taken in the outpatient clinic. The physicians’ average Vancouver scar scale (VSS) of first physician was 1.26 and second physician was 1.2. Compared with the conventional transconjunctival approach, the extended transconjunctival approach with paracanthal incision had similar complication and scarring rates, as well as a lower scarring rate than the subciliary approach while providing much wider surgical fields.