Transconjunctival Midface Lift in San Diego, CA
If a previous lower eyelid procedure has left your eye looking more open, rounded, or “pulled down” than you expected — sometimes with visible white showing below the iris that wasn’t there before — you may have a condition called lower eyelid retraction, and it’s a fixable problem that requires a specific kind of expertise to correct well.
Why this happens
Lower eyelid retraction is a well-recognized complication that can occur after cosmetic lower eyelid surgery (blepharoplasty) performed through an external incision, just below the lash line. Scarring or tissue changes from the original surgery can gradually pull the lower eyelid margin downward, changing both the shape of the eye and, in some cases, its ability to fully protect the eye’s surface.
How this procedure corrects it — without an external incision
The transconjunctival midface lift is performed entirely from inside the lower eyelid, through the conjunctiva (the inner surface of the eyelid) — meaning there’s no new external incision or visible scar. Working through this internal approach, Dr. McCoy accesses the deeper support structures of the cheek and midface below the eye, releases the tissue that has become tethered or scarred, and lifts the cheek and SOOF (the deeper fat pad supporting the lower eyelid and cheek) upward, anchoring it with internal sutures to provide lasting support to the lower eyelid margin. This restores the eyelid’s natural position and support from beneath, rather than simply adjusting the eyelid itself.
Why this is a specialized procedure
This technique is performed almost exclusively by oculoplastic surgeons — it requires the same combination of ophthalmic and reconstructive training that defines the specialty. If a prior lower eyelid procedure didn’t give you the result you expected, this is often the point at which a second opinion from a specialist in this exact technique makes the difference.
“Helping someone overcome a functional challenge or simply feel better about themselves is an indescribable feeling.”
~Dr. Allison McCoy
Setting and anesthesia
This procedure is typically performed at an ambulatory surgical center under local anesthesia with monitored anesthesia care (MAC), or under general anesthesia, depending on the case and what else is being done at the same time.
Recovery
“Frost” sutures are often placed to keep the lower eyelids on gentle upward stretch for one week after surgery, and an eye patch is sometimes used when surgery is performed on one side only. Sutures are removed after one week.
“My practice philosophy is all about choice. It’s about empowering and educating people, providing a full suite of options that goes beyond surgery and focuses on their total health.”
~Dr. Allison McCoy
Frequently Asked Questions
How do I know if I have lower eyelid retraction?
Common signs include visible white (sclera) below the iris that wasn’t there before a prior eyelid procedure, a rounded or “surprised” look to the eye, eyelid discomfort or dryness, or a sense that the lower eyelid no longer sits where it used to.
Will this leave a visible scar?
No — the procedure is performed entirely through an incision inside the eyelid.
Is this the same as a standard lower blepharoplasty?
No. A standard lower blepharoplasty addresses excess skin or fat. This procedure specifically addresses lower eyelid retraction — a change in eyelid position and support — often as a corrective step after a previous external-approach lower eyelid surgery.
Can this be combined with fat grafting or other volume restoration?
Yes — when additional volume is needed in the midface or under the eyes, fat grafting is sometimes performed at the same time.