This is how cosmetic eye surgery can be performed inside the eye

Q One of my friends had eye surgery and said she did it from the inside. Is it possible?

A. Yes it’s possible. Your girlfriend probably had transconjunctival blepharoplasty. She’s probably talking about her lower eyelid surgery; the upper eyelid is usually done with an external incision.

Blepharoplasty, or eye surgery, can be performed both externally and internally.

Upper eyelid surgery is simple in that the incision is made on the outer skin in the normal crease. The idea is to remove extra skin and if there is a bulge near the nose, remove parts of the medial fat pad. Most surgeons who perform this procedure do so using a similar method.

Lower eyelid surgery is performed externally when skin and some muscle need to be removed along with three of the prominent fat pads. I usually start with the most lateral fat pad to remove the necessary fat so the eye looks rejuvenated. Care should be taken not to take too much or leave extra fat behind.

When surgery is performed externally, a surgeon must not remove too much skin or risk changing the shape of the eye or causing ectropion or malposition. These occur when the lid does not rest against the eye, creating medical and cosmetic deformity.

When a patient is young, has had previous surgery, and has residual fat, the trans-conjunctival incision – inside the eye – is made. This means that you can remove excess fat without an external incision.

Another reason to do this is when a patient has an eyelid malposition where part of the white part of the eye is visible between the iris and the lower eyelid. By making the incision inside the eye, an incision is made in some of the depressor muscles of the eyelid. This way you get some elevation so the eye looks more normal after surgery.

When looking to get your eyes done, you should choose a facial plastic surgeon, an oculoplastic surgeon, or a plastic surgeon who performs facial surgery.

Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email him your questions at Cwolf@miamiplasticsurgery.com