Surgery · Technique

Transconjunctival vs Subciliary Lower Blepharoplasty

Two ways into the lower lid, and what decides between them

Gangnam, Seoul | Board-certified plastic surgeon, Dr. Jonghwan Choi
Route chosen per lid by the operating surgeon · KHIDI-registered for international patients

Transconjunctival or Subciliary Inside or Below the Lashes Transconjunctival or Subciliary Inside or Below the Lashes Transconjunctival or Subciliary Inside or Below the Lashes Transconjunctival or Subciliary Inside or Below the Lashes 
Route

Lower blepharoplasty approaches

What is transconjunctival lower blepharoplasty, and how does the subciliary approach differ?

The short answer

Both are routes into the lower eyelid. A transconjunctival approach enters through the conjunctiva, the moist lining on the inside of the lid, so the skin is not cut. A subciliary approach enters through the skin just below the lower lashes, which opens the front of the lid and can leave a fine line along the lash row. Rewind's lower blepharoplasty page names both routes and states the consequence directly: through the conjunctiva no scar is visible, through the skin a scar can form beneath the lashes. Which is used is decided by the condition of the under-eye tissue, the elasticity of the skin and how far the lid has descended.

Facts on this page come from Rewind's pages for lower blepharoplasty, septal-reinforced fat repositioning and the apple-cheek midface lift. The fat repositioning page does not publish an incision route, and none is assigned to it here.

Searches for this comparison often ask why Korean eye bag surgery defaults to the inside approach. One clinic cannot speak for a country's operating rooms, and this page does not try. What it can do is set out how the two routes differ, what Rewind itself publishes about using them, and which features of a lower lid move the choice one way or the other.

Magnified lower-lid work in the operating room at Rewind Plastic Surgery
Fig. 01 — The route into the lower lid is chosen before the first incision
Cases

Case photographs

Lower-lid cases from Rewind, captioned by operation

The captions below name the operation performed. They do not name the incision route, because the route for each session is not part of the published record, and a photograph taken after healing is not a reliable way to tell the two approaches apart.

Rewind patients, lower lid

Before: under-eye fat repositioning for protruding fat, front view After: under-eye fat repositioning for protruding fat, front view BEFOREAFTER
single operation
Under-eye fat repositioning for protruding fat, no other procedure
Individual results may vary.
Before: under-eye fat repositioning, oblique view After: under-eye fat repositioning, oblique view BEFOREAFTER
single operation
Under-eye fat repositioning seen from an oblique angle, no other procedure
Individual results may vary.

Rewind's own patients, photographed at the clinic and published unretouched; each caption lists the full session. Individual results may vary. Lower-lid surgery by either route can cause bleeding, bruising, prolonged swelling, asymmetry and a change in lid position, and a skin route can leave a visible line.

Reach

What each route reaches

What the transconjunctival and subciliary approaches can each reach

An approach is a door. What matters is what can be done once through it, and what the door itself leaves behind.

route 01
Transconjunctival: the fat
Working from inside the lid reaches the fat behind the septum without opening skin. It fits a lower lid whose problem is fat, bulging or waiting to be moved, with skin that has kept its elasticity.
route 02
Subciliary: skin and muscle too
An incision beneath the lashes opens the front of the lid, so skin and the muscle beneath it are within reach as well as the fat. That access is the reason elasticity and descent enter Rewind's decision.
trade-off
The line left behind
Rewind's page: no visible scar through the conjunctiva; a scar can form below the lashes through the skin. Its midface page adds that how visible that line becomes varies with the elasticity of each person's skin.
behind the door
The groove and the septum
Ligament release and fat transfer into the tear trough are steps of the operation itself, described on Rewind's repositioning page without reference to route. The approach is planned separately from them.

Rewind also uses the inside route above the lid. Its apple-cheek midface lift is described as reaching the midface through the conjunctiva or the skin of the lower lid, with the incision made inside the conjunctiva to keep scarring to a minimum. That is a different operation with its own page, but it shows the same principle applied higher in the face.

Choose

The decision

How a lower blepharoplasty approach is chosen at Rewind

Rewind names three factors on its lower blepharoplasty page. Two more, the history of the lid and your own priorities, complete the conversation.

01Tissue

The condition of the under-eye tissue

How much fat protrudes, whether there is a groove to fill and how the septum behaves set out what has to happen behind the lid. That plan comes first; the route follows from it.

02Elasticity

The elasticity of the lid skin

Skin that has kept its elasticity gives little reason to be opened. Skin that has lost it may need attention an inside route cannot give, because the conjunctiva lies behind the skin.

03Descent

How far the lid has descended

A lower lid that has sagged is judged together with the cheek below it. Where the midface has dropped as well, the discussion can extend to the apple-cheek midface lift, a separate operation.

04History

Previous surgery on the lower lid

Earlier operations leave altered tissue and can change lid position. Rewind's midface page lists patients whose lower lid turned outward after lower blepharoplasty among its candidates, a reminder that lid position is what both routes are planned to protect.

05Priority

What you are prepared to trade

A route with no skin incision leaves nothing to see but reaches only what lies behind the lid. An outside route reaches more and leaves a fine line. Where a lid would allow either, the trade is explained and your preference is part of the decision.

Rewind's medical director at the operating table
Fig. 02 — Route and surgical plan are settled together
Rewind

Why here

Why the lower blepharoplasty approach is left to the operating surgeon at Rewind

Rewind's lower-lid page describes both routes, so the question at consultation is which door your lid needs, and the answer can be either.

01Both routes

Both lower-lid approaches are in use

Rewind's own page presents the conjunctival and the skin approach side by side and ties the choice to three features of the lid. The recommendation is not narrowed to whichever route a practice happens to prefer.

02Research

The director has published on the subciliary route

Dr. Jonghwan Choi co-authored a 2016 paper on improvement of the nasojugal groove, the anatomical name for the tear trough, and its wrinkles after elevating a skin-muscle flap through a subciliary approach to the orbital rim. The series is reconstructive and not a study of cosmetic blepharoplasty, but it documents direct work through the outside route.

03Continuity

The surgeon who chose the route reviews the healing

Whether the line sits inside the lid or under the lashes, the same board-certified plastic surgeon examines it at each review. Rewind is a KHIDI-registered institution for international patients, M-2025-01-08-09288.

Paper on the nasojugal groove and a subciliary approach to the orbital rim, co-authored by Dr. Jonghwan Choi
Fig. 03 — The director's co-authored work on the subciliary route
Theatre

On the day

What lower blepharoplasty at Rewind involves on the day of surgery

Preparation in the procedure room at Rewind Plastic Surgery

Fig. 04 — Preparation before lower-lid surgery

Patient lounge at Rewind Plastic Surgery, Apgujeong

Fig. 05 — The patient lounge on the clinic floor

Rewind operates on the fourth and fifth floors of the Richro Building in Apgujeong, Gangnam, Seoul. The route is confirmed with you before surgery, the medical director performs the operation, and the lower lids are dressed before you go home; the under-eye dressing stays on for three days.

Conjunctival route: no visible scar
Skin route: possible line under the lashes
Route set by tissue, elasticity and descent
Lower blepharoplasty sutures out at 5–7 days
Under-eye dressing kept on for three days
No strong pulling on the lid for a month
Performed by Dr. Jonghwan Choi
Healing checked by the same surgeon
Dr. Jonghwan Choi, board-certified plastic surgeon

Board-certified plastic surgeon

A board-certified plastic surgeon in Korea, Dr. Jonghwan Choi has co-authored ten peer-reviewed papers. KHIDI registration for international patients: M-2025-01-08-09288.

Cost

Pricing

Lower blepharoplasty cost at Rewind, by operation

Rewind lists lower-lid surgery by what is done to the lid. The route is not a separate line, so the operations below are the ones a choice of approach belongs to.

Lower blepharoplastyFat removed or relocated, muscle dissected and fixed to the periosteum
₩3,900,000
Under-eye fat repositioningTear-trough ligament released and the fat moved into the groove
₩1,600,000
Septal-reinforced fat repositioningRepositioning with the septum fixed to the orbital bone
₩2,000,000
Apple-cheek midface lift, transconjunctival, on its ownThe inside route applied to a descended midface
₩4,000,000

The one place a route appears by name on Rewind's price list is the midface, where the apple-cheek lift on its own is listed as a transconjunctival operation. For the lower lid itself the list prices the operation and does not separate the approach.

List rates, VAT excluded, anaesthetic fee included. The operation and the route are both confirmed after examination.

Fit

Suitability

Which lower lids suit a transconjunctival approach, and which a subciliary one

The inside route tends to be considered for

  • Protruding fat with lid skin that has kept its elasticity
  • A tear-trough groove to be filled with relocated fat
  • Patients for whom any visible line is a particular concern
  • Lower lids without marked descent
  • A bulge that is the only finding at examination
  • Lids where the plan behind the septum is the whole operation

The skin route, or a different plan, tends to be considered for

  • Marked skin laxity around the eye
  • A lower lid that has visibly descended
  • Previous lower-lid surgery with a change in lid position, which calls for its own assessment
  • A cheek that has dropped below the lid, where the midface is discussed
  • Pigment in the skin, which no route lightens
  • Dry or irritable eyes, active inflammation or a bleeding tendency, which postpone surgery
After

Recovery

Healing after transconjunctival and subciliary lower blepharoplasty

Rewind's post-operative sheet for lower blepharoplasty does not change with the route: the same dressing, the same week without heat, the same month without pulling. What differs is whether there is a line on the skin to protect.

Days 1–3
Dressing stays in place
The under-eye dressing is left on for three days whichever approach was used, and is not lifted to inspect the result.
About 5–7 days
Suture removal
Rewind's lower blepharoplasty page gives roughly five to seven days to suture removal.
1–2 weeks
Bruising and swelling decrease
Early swelling and bruising settle over one to two weeks, differing between people. Saunas, steam rooms and hard exercise are avoided for at least the first week, and daily sunscreen also shields a healing line beneath the lashes.
About a month
No strong pulling
The area is not pulled or stretched hard for about a month, and alcohol, smoking and sauna are set aside for a period.

Named risks for either route include bleeding, infection, prolonged swelling, asymmetry, altered sensation, dry eye and changes in lower-lid position such as retraction or ectropion, which the surgical literature treats as the complication to plan against. A skin route can also leave a visible scar. Results vary between individuals and cannot be promised.

Doctor

Professional

At Rewind, one board-certified plastic surgeon carries every case — from the first consultation to the final follow-up. Because a face is a story, and a story deserves a single author.

Dr. Jonghwan Choi, board-certified plastic surgeonRewind,
Dr. Jonghwan Choi presenting at an academic session
Fig. 06 — Academic presentation, thread-lifting session

Rewind's Doctor

Dr. Jonghwan Choi Medical Director

One surgeon, from the first
consultation to the last follow-up.

A board-certified plastic surgeon devoted to anti-aging lifting — with the precision and restraint built through years of craniofacial practice.

Board-certified plastic surgeon (Plastic Surgery)
10 peer-reviewed publications
Medical Director, Rewind Plastic Surgery
Korean Society of Plastic & Reconstructive Surgeons
Former chief director, Apgujeong Y&T Plastic Surgery
Korean Society for Aesthetic Plastic Surgery
J Craniofac Surg · JKMS · Arch Craniofac Surg
Korean Cleft Palate-Craniofacial Association
Ask

Questions

Transconjunctival or subciliary: questions about the lower-lid approach

Which lower eyelid approach avoids an external scar?
The transconjunctival approach. It enters through the conjunctiva on the inside of the lid, and Rewind's lower blepharoplasty page states that no scar is visible with it. The skin approach, beneath the lashes, can leave a scar there.
Why is the transconjunctival route so often linked with Korean eye bag surgery?
Rewind can only describe its own practice. Its page presents the conjunctival route as leaving no visible scar and the skin route as a trade: wider access to the lid, with a possible line beneath the lashes. The choice is made per patient, by tissue condition, skin elasticity and descent.
Can loose lower-lid skin be treated through the conjunctiva?
The conjunctiva lies behind the skin, so an inside route leaves the skin unopened. That is why skin elasticity is one of the three factors Rewind names. Where the skin itself has loosened markedly, the outside route or a broader plan is discussed at examination.
Which route does Rewind use for under-eye fat repositioning?
Rewind's septal-reinforced fat repositioning page does not publish an incision route, so this page does not state one. The route is set for each patient on the same criteria as lower blepharoplasty and is confirmed at your consultation.
Is a subciliary scar noticeable?
Rewind's midface page answers that it depends on the elasticity of each person's skin, and that a scar may show beneath the lashes when the lower blepharoplasty route is taken. The line follows the lash row; sunscreen while it heals is part of the aftercare.
Does the approach change the recovery?
Rewind gives one set of instructions for both. The dressing stays on for three days, sutures are removed at roughly five to seven days, swelling and bruising decrease over one to two weeks, and strong pulling of the lid is avoided for about a month.
What is the main risk to plan around with either approach?
Lower-lid position. Surgical reviews of lower blepharoplasty discuss retraction and ectropion as complications to prevent and correct, and Rewind's midface page lists a lid turned outward after lower blepharoplasty among its indications. Bleeding, infection and asymmetry are also possible.
Is the approach priced differently?
There is no separate line for the route on Rewind's list. Lower blepharoplasty, fat repositioning and septal-reinforced repositioning are priced by operation. The one place a route appears is the apple-cheek midface lift, listed on its own as a transconjunctival operation.
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What our patients say.

G 5.0 ★★★★★ 51 Google reviews · Rewind Plastic Surgery, Apgujeong — live-synced from Google Business Profile
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Came to REWIND to get my facial treatment and i'm absolutely obsessed about it💞 the doctor is so kind and is an expert! Everyone must visit!

YunHee Hong2 weeks ago
★★★★★

There are just way too many cosmetic clinics in Korea and I'm so happy I found Rewind Clinic in Gangnam. Dr. Choi was so kind and patient while explaining the different face-lifting options, from threads to mini-lifts to deep-plane lifts…

J. S.5 months ago
★★★★★

I found Rewind clinic through a Korean chat forum and many local clients highly recommended it. The clinic is brand new, featuring large, clean rooms and many private waiting areas so it doesn't give off that "factory" clinic vibe. All the…

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★★★★★

Really nice environment. Doctor is easy to communicate and understands my visions. Waited two weeks to make a review and I confirm the results exceeded my expectations and I am super happy with it. Can't wait to come back!! :))

Kristie Chu5 months ago
★★★★★

I received a thread lift at Rewind Plastic Surgery. The clinic was clean and the atmosphere was comfortable. The consultation was thorough, and I felt confident because they kindly explained everything tailored to my facial condition. They…

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Scientific evidence

Research on the transconjunctival and subciliary routes into the lower lid

These four papers bear on the choice of route: a subciliary series to the orbital rim co-authored by Rewind's medical director, reported outcomes of transconjunctival repositioning, a review of preventing and correcting lower-lid malposition, and a systematic review of lower blepharoplasty complications.

Each reports its own authors' patients and methods. The first is a reconstructive series; none is a study of lower-lid surgery as performed at Rewind, and none predicts how a particular incision will heal.