The Transconjunctival blepharoplasty is receiving extending attention as an alternate technique to traditional transcutaneous blepharoplasty. Transcutaneous blepharoplasty has been linked with the round eye presence, inferior scleral show, and frank ectropion, which is the invariable consequence of overgenerous skin resection. These techniques include wedge excision, lateral canthoplasty or canthopexy, and periosteal flap fixation based on the sideway orbital margin. Transconjunctival blepharoplasty has been supported to limit the incidence of these difficult situation, particularly in patients with minimal skin.

Transconjunctival blepharoplasty has been appreciated as useful in patients with fat excess and fine skin wrinkling and in those with apparent skin and fat excess in whom fat excision alone allows for redraping of the lower lid skin into an acceptable contour with elimination of the skin laxity. Lower lid blepharoplasty does notexterminate fine skin wrinkling regardless of which technique is used. This issue is better addressed with either chemical peels or laser resurfacing. Use of transconjunctival  higher blepharoplasty may be constrained for the patient.

The transconjunctival way is a better option in patients who certain concerns about scarring with the transcutaneous approach. Although the resultant transcutaneous scar is almost inappreciable ,depigmentation at the scar line sometimes occurs in darker-skinned individuals. With a high tarsal press with no central or lateral fat pad herniation and minimally redundant upper eyelid skin and for patients who present with residual fullness of the upper eyelid following prior blepharoplasty. Candidates for blepharoplasty generally present with fat herniation and are sad with the bags, puffiness, or dark circles under their eyes.

Transconjunctival blepharoplasty allows access to the orbital fat by an incision through the inferior fornical conjunctiva and capsulopalpebral fascia without any disorder of the skin and muscle of the lower lid. This results in a decrease in the risk of ectropion and round eye syndrome, which may complicate the transcutaneous approach. Transconjunctival blepharoplasty is simply achieved with local or general anesthesia. When performed as an alone procedure, the authors prefer local anesthesia with or outside intravenous sedation.