[Inferior blepharoplasty: the transconjunctival approach].

Described in 1924 by J. Bourguet, the transconjunctival approach seems to have experienced a resurgence of interest in recent North American publications. The incision, made under local anaesthesia along the inferior border of the tarsal cartilage, provides a plane of dissection which can be either preseptal, in which the approach to the bags is made through the septum as in the classical approach, or alternatively retroseptal, a route which respects the integrity of the septo-orbicular suspension, and allows a direct approach to th bags. Removal of fat should be limited to the excess tissue which protrudes when pressure is applied to the globe, using the orbital rim as a landmark. After haemostasis, closure is provided by means of a gathering stitch which is removed on the 4th day. The indications are young patients who present with bags with no excess of either skin or muscle (preseptal approach), dark-skinned patients in whom there is a risk of scarring (keloid), and older patients (retroseptal approach) who present with hyperlaxity of the septo-ligamentous mechanism, and in whom the "round eye" or an ectropion might result from a classical approach. In this last group, the excessive skin may be excised a minima without undermining. Finally, in cases of fat remnants after the classical approach, the transconjunctival approach offers an easy solution. Complications are extremely rare. It is for this reason that the transconjunctival approach is tending to become the standard approach for many modern authors.