Answer:
Transconjunctival blepharoplasty can be performed under general anesthesia or under local anesthesia with sedation. An incision is made 1-2 mm below the caudad margin of the inferior tarsus through the conjunctiva and the capsulopalpebral fascia. The fat is then excised in a graduated fashion from the lateral, central, and medial compartments, with the level of the inferior orbital rim serving as the landmark to prevent overresection of fat. The conjunctiva is generally not sutured at the completion of the procedure to avoid irritation by suture material.
The main advantage of the transconjuctival approach is that there is no external scar. Another proposed advantage is that there is less ectropion because of less scarring from going through the skin and orbicularis oculi. The disadvantages include difficulty in locating the proper tissue planes and fat compartments and inability to tighten lower lid laxity or remove excess skin, although it is argued that there is usually not much excess skin. Attempts at removing the fine wrinkles in the lower lid skin with excess skin resection may lead to ectropion.