For lower eyelid surgery, are the incisions always made inside of the eyelid?

Question:
For lower eyelid surgery, are the incisions always made inside of the eyelid? Is a skin incision ever needed and if so, why?

Answer:
We usually perform lower eyelid incisions on the inside. The reason for this being that making an external incision requires dissecting through the muscle of the lower eyelid which puts the lower eyelid at risk for malposition following the surgery. If a skin excision is required, we usually will perform an incision inside the eyelid to access the fat pads followed by skin removal through an incision on the outside of the eyelid just below the lashes. This allows for excision of skin without violating the muscular layer.

Posted by Dr. Buckingham