Quantified Incision Placement for Postseptal Approach Transconjunctival Blepharoplasty

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This study quantifies the incision location in transconjunctival lower eyelid blepharoplasty to optimize postspetal (direct) access to the eyelid/orbital fat.


A retrospective chart review of patients undergoing transconjunctival blepharoplasty by one surgeon (GGM) from January 2013 to January 2014 was performed. Simultaneous globe retropulsion and lower eyelid inferior displacement was used to balloon the conjunctiva forward to maximally visualize the transconjunctival surface anatomical landmarks of importance. A caliper was used to measure the distance in millimeters from the inferior tarsus to the most superior projection of visible fat. The conjunctival incision was made 0.5 mm posterior to this measured distance. For each procedure it was noted whether the preseptal or postseptal plane was entered.


Sixty-six patients were assessed. Fifty patients were women, and the mean patient age was 54 years (range 36–71 years). The mean distance from the inferior tarsus to the visualized superior tip of fat was 6.03 mm (range 5–7 mm) and the mean incision placement was 6.53 mm (range 5.5–7.5 mm). The postseptal space (direct access to fat) was entered in 54 cases (82%). The inferior vascular arcade was identified in 23 cases (35%) cases. In this instance, the incision was placed below this landmark in 16 cases (70%). There were 5 cases (7.6%) of postoperative chemosis which all resolved within 2 months with conservative measures. There were no other complications related to the conjunctival incision.


Placing the conjunctival incision for postseptal approach transconjunctival blepharoplasty 0.5 mm posterior to the most superior projection of clinically visible fat (with adjunctive globe retropulsion and lower eyelid infraplacement) accesses the postspetal space directly in 82% of cases. Previously suggested incision placements: between 2 and 5 mm below the tarsus, at the fornix, or at the inferior vascular arcade are subjective/anecdotal at best and without similar quantitative validation.

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