Jeannine Morrissette: I did have an email this week. She went for a consultation on a bleph. She did not understand what the transcon meant. Dr. Michael Salzhauer: Okay, a bleph, in the plastic surgery world, that’s a blepharoplasty, which is an upper eyelid or lower eyelid lift. They’re different on the upper and lower eyelids, obviously. The upper eyelids, usually we make an incision in the natural skin crease, the fold above your eye. We take out the extra skin and we take out whatever fat might be bulging and then sew it up. That scar tends to heal real well and fades to almost nothing after a few months and is almost hard to find it. The lower eyelids is a different story. Lower eyelid surgery is a much more complicated, much more fraught with difficulty and potential problems than upper eyelid surgery. For many, many years, the most common incision was just below the lash line in the lower eyelids, but even in the best hands, even the surgeons who do nothing by eye surgery, and there re a number of them both here in Miami and New York. Even in those hands, they found a fairly high rate of complications, usually with the scar contracting and drawing down the lower eyelid and making it look a little bit sad. If you’ve seen patients that have had eyelid surgery done that way with that complication, it really is an unattractive look. Now partly to counteract that, surgeons in the late 80’s and 90’s began to operate on the lower eyelid by an incision through the inside of the eye. That leaves no scar on the outside and the surgeons who use that incision generally have a much lower rate of that complication that I was just mentioning to you. In our practice, I would say I do 90% of my lower eyelid surgeries transcon, which means transconjunctival or through the lower eyelid, on the inside of the eye, without leaving a scar on the outside. So that’s a very good question, a little bit complicated answer.

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