Introduction: Transconjunctival lower blepharoplasty has become more popular in the last decade with the introduction of the CO2 laser as a cutting and resurfacing tool. The authors have 4 years experience with this procedure. Method: Patient selection, preoperative evaluation and the surgical technique are described in detail. The operation itself is divided into two parts: 1. Laser-assisted transconjunctival exposure and resection of prolapsed fat pads, 2. Laser resurfacing of the lower eyelid skin. Results: 36 patients underwent transconjunctival, laser-assisted lower blepharoplasty in the author’s department in the period 1997–2000. Transitional hyperpigmentations were treated in 4 patients (11,1 %). No severe complications were noted. All patients except one were satisfied or very satisfied. Discussion: Transconjunctival and transcutaneous lower blepharoplasties are compared: 1. Transcutaneous blepharoplasty is simpler to perform, some skin resection is possible and no laser device is needed. 2. The danger of ectropion is relatively high in transcutaneous blepharoplasty, and the scar may not be fully acceptable for the patient. 3. Aged and sun-damaged skin is not influenced with the transcutaneous approach except for some improvement of rhytides. 4. Transconjunctival lower blepharoplasty is a relatively safe procedure with very good cosmetic results avoiding an incision and scar of the lower eyelid. 5. There is much less risk of ectropion and other complications in transconjunctival blepharoplasty than in the transcutaneous one. 6. An unpleasant side effect in transconjunctival blepharoplasty is erythema of the lower eyelids persisting for about 2-3 months. Conclusion: Laser-assisted transconjunctival lower blepharoplasty requires a shorter operating time and causes less bleeding and less patient discomfort. This is full-value alternative to the conventional transcutaneous lower blepharoplasty.

        Key words: transconjunctival lower blepharoplasty, CO2 laser technique, festoon reduction, lower eyelid skin resurfacing